Podcasts about institutions

DW is an Interdisciplinary Artist & Creative Leadership Consultant. Growing up they often dissociated themselves from their Blackness, Queerness, and gender non-conforming spirit, believing their self erasure would create better opportunities for career growth. DW's InstagramDW's TikTokEmail DW: darestorativehomie@gmail.comCheck out our LIVE EventsSend us feedback at media@amplifyrj.comJoin our Mighty Networks platform to connect with other people doing this work!Rep Amplify RJ Merch You can connect with Amplify RJ:Email list, Instagram, LinkedIn, Facebook, Twitter, Website, Reading list, YouTube, and TikTok!SUPPORT by sharing this podcast, leaving a rating or review, or make a tax-deductible DONATION to help us sustain and grow this movementJoin David and Kala on Sunday March 19, 9am Pacific/12pm Eastern for a LIVE workshop on Freedom Dreaming a Thriving Community (even under apocalyptic circumstances).Surviving Humanity: A Self-Help PodcastImprove your anxiety, depression, motivation and productivity; new episodes every Tuesday.Listen on: Apple Podcasts SpotifySupport the show

Photo: No known restrictions on publication. @Batchelorshow #Israel: @SCOTUS;  Institutions and partisanship collide. Richard A. Epstein, Hoover Institution https://www.msn.com/en-us/news/world/israeli-protesters-paint-red-line-leading-to-supreme-court-after-netanyahu-spurns-compromise/ar-AA18HoFp

Plant Based Treaty urges cities & institutions: go vegan by Jordi Casmitjana at UnchainedTV.com   Original Post: https://unchainedtv.com/2023/01/16/plant-based-treaty-urges-cities-institutions-go-vegan/  UnchainedTV is a non-profit media organization focusing on animal rights, the plant-based, cruelty-free lifestyle, climate change, food justice, health, and associated issues like human world hunger and workers' rights. They profile vegan activists and celebrities and reports on animal rights news, issues, and events, bringing the world crucial information ignored by advertiser-based mainstream media. It was founded by Jane Velez-Mitchell, nationally known TV journalist and best-selling author. For six years she hosted her own show on CNN Headline News, where she ran a weekly segment on animal issues, and now, with JaneUnchained, she covers crimes against animals, and the environment.  They have a free vegan TV app and streaming service called UnchainedTV,the only streaming service featuring the New Day New Chef cooking show, and hundreds of other Vegan originals, documentaries, specials, and plant-based programming for FREE! Download the UnchainedTV app, or visit unchainedtv.com.     How to support the podcast: Share with others. Recommend the podcast on your social media. Follow/subscribe to the show wherever you listen. Buy some vegan/plant based merch: https://www.plantbasedbriefing.com/shop    Follow Plant Based Briefing on social media: Twitter: @PlantBasedBrief YouTube: YouTube.com/PlantBasedBriefing  Facebook: Facebook.com/PlantBasedBriefing  LinkedIn: Plant Based Briefing Podcast Instagram: @PlantBasedBriefing   #vegan #plantbased #veganpodcast #plantbasedpodcast #plantbasedbriefing #unchainedTV #plantbasedtreaty #climatechange #climatecrisis   

Robert has a dynamic company at Mioym Equities and he raises for both an SFR Flipping Fund with LP's and for Multifamily Syndications where he raises from Institutions. Let's here him talk about both and how he came up from Wall Street and moved into real estate.    Check out Robert at info.mioymequities.com   Get all your capital raising marketing materials done for you at pitchdecks.com  If you would like to find out more about Family Office Capital Raising events you can visit lnkd.in/gD6mJ5gp Book a call with Ruben at calendly.com/rlgreth

It's always fun to talk shop with people who started with The Wolf of Wall Street lifestyle and transitioned into raising capital for multifamily syndications. We discuss the following on today's show: Going from Broker Dealers and RIA Management to Real Estate Capital Raising Learning from The First Real Estate Deal Managing a Fix and Flip Fund Raising from Institutions for Multifamily Capital Raising Concepts Learned from Financial Advisory Robert's Roles, Responsibilities and Capital Management Being Direct in Investor Conversations Raising from LP's vs Institutions Check out Robert at info.mioymequities.com   Get your videos produced and all your capital raising marketing at pitchdecks.com like the Capital Raiser Show. If you would like to find out more about Family Office Capital Raising events you can visit lnkd.in/gD6mJ5gp Book a call with Ruben at calendly.com/rlgreth  

The onset of the pandemic in 2020 marked a turning point in the 30-year pursuit of successful global poverty reduction. According to recent World Bank estimates, the incomes of the poorest 40 percent of the world's population likely fell by 4 percent in 2020. And as a result, the number of people living in extreme poverty likely increased by 11  percent in 2020—i.e. it increased from 648 million to 719 million. The pandemic also increased global inequality. In terms of lost income, the world's poor paid the highest price for the pandemic; Indeed, the percentage income losses of the poorest are estimated to have been double those of the richest. The rise in extreme poverty and decline of shared prosperity caused by inflation, currency depreciations, and broader overlapping crises facing development, pose numerous challenges for global development.Indermit Gill is Chief Economist of the World Bank Group and Senior Vice President for Development Economics. Before starting this position on September 1, 2022, he served as the World Bank's Vice President for Equitable Growth, Finance, and Institutions, where he played a key role in shaping the Bank's response to the extraordinary series of shocks that have hit developing economies since 2020. Between 2016 and 2021, he was a professor of public policy at Duke University and non-resident senior fellow at the Brookings Institution's Global Economy and Development program. Indermit has published extensively on policy issues facing developing countries, sovereign debt, green growth, labor markets, poverty and inequality, and managing natural resource wealth. His pioneering work includes introducing the concept of the “middle income trap” to describe how developing countries stagnate after reaching a certain level of income. Indermit also spearheaded the influential World Development Report 2009: Reshaping Economic Geography. Twitter: @IndermitGillResources:The New Threat to Prosperity Everywhere (Indermit Gill, 13 March 2022, Project Syndicate)Poverty and Shared Prosperity 2022 (World Bank report)Key highlights:Introduction - 00:52How "development" has changed over the years - 03:22The current status of the World Bank's twin goals - 08:56Growing global poverty and how to best measure poverty - 13:38The "middle income trap" and natural resource curse thesis - 21:00Sustainable development, renewal energy, and climate change- 29:50Addressing the debt crisis - 40:15 Host:Professor Dan Banik, University of Oslo, Twitter: @danbanik  @GlobalDevPodApple Google Spotify YouTubehttps://in-pursuit-of-development.simplecast.com/

Listen to ASCO's Journal of Clinical Oncology essay, “I Want to Kill You” by Dr. Noelle LoConte, Associate Professor of Medicine at the University of Wisconsin School of Medicine and Public Health. The essay is followed by an interview with LoConte and host Dr. Lidia Schapira. LoConte shares her experience of a patient's threat to kill her and her reflections on how health care can be improved. TRANSCRIPT Narrator: I Want to Kill You, by Noelle K. LoConte, MD (10.1200/JCO.22.02896)  My patient threatened to kill me. I was in the middle of a busy medical oncology clinic. I was seeing her to discuss test results 1 week after I told her I was concerned that her cancer had returned. As I suspected, the test confirmed recurrent cancer, and this time, it was incurable. I walked into the room to share this news with a woman who I had been seeing for about 3 years. I had been her oncologist since she was first diagnosed with stage III cancer and saw her through surgery and adjuvant chemotherapy. I had met her children, knew the names of her pets, and had discussed my children and pets with her. We were on very friendly terms, and I enjoyed seeing her name on my clinic schedule, certain that beyond discussion of her cancer and test results, we would also get into some interesting conversations about life, the weather, or college sports. Truly, it was a delight to be her oncologist. She had no known mental illness, no brain metastases, and had never been angry or violent with me. I used the SPIKES protocol to review why we were there and deliver the test results.1 I had done this many times before, and there was nothing that stood out to me in the moment about her or this clinical situation to make me think that I was in danger—a fact that made what happened next even more shocking. When I paused to see what questions or thoughts she had, she said, “I want to kill you. I want to blow your face off. You should never have become a doctor.” I intellectually understood that she was upset about the news of her cancer recurrence and had understandable anger at the dramatic impact this turn of events would have on her future. I understood that, in her mind, someone had to be blamed, and, mostly out of convenience, it was going to be me. I have since wondered if her lack of close friends and family may have amplified her reaction, in that she had few outlets available to her to discuss her fears and concerns. I have wondered if she felt let down by me after our years of cordial and friendly visits. It was a real-life example of kill the messenger.  She continued telling me that she could find my home address. At that moment, I scanned the room and recognized that I could be in real danger. I stood in the corner of the room. To get out, I would have to walk around the desk and between her and the examination table. I also realized that because it was a holiday, there were very few people around who might hear me yell for help. We did not have a panic button or hospital security on speed dial, and it would have taken them many minutes to get to me if I had used the phone in the examination room to call security. I looked down and saw that she had two large bags with her. Patients often bring bags such as these to their chemotherapy appointments, bags filled with things to pass the time such as iPads, books, knitting, board games, blankets, snacks, and water bottles. Suddenly, I realized that she was not scheduled to get chemotherapy that day, so why did she have these bags?  I was sure I was about to be killed. I was certain she had a gun in those bags.  I said anything I could think of to de-escalate the situation and get out of the room. I promised her a new oncologist, told her I would become a better doctor, and suggested that maybe the biopsy results were wrong (although I knew they were not). As she continued her tirade, I carefully walked past her to get out of the room, and although she never moved toward me, she continued to yell about what a terrible person I am. Once I was back in the workroom, a nurse escorted the patient out of the clinic. We called hospital security and were told they felt their services were not needed as the patient had left the clinic.  Despite this horrific encounter, I managed to make it through the rest of the clinic day in a daze. After the clinic was finished, I emailed my supervisor since it was a holiday and other employees were not in the hospital for me to call. In this email, I conveyed my fear and concern about this encounter while making it clear that I was still worried about my safety and the ability of the patient to continue to harm me. The response I received was generic: We will look into it. The very next day while I was at home, I received an alert that there was an active shooter in the area and realized with dread that it was on my block. It was not my patient, but her words about finding my home address haunted me. I hid on the floor after closing the blinds and locking all the windows and doors. My children were with me. For days, I did not sleep more than 1 or 2 hours. I was on constant high alert.  Three days later, I was seeing a different patient in the clinic and had what I now realize was a panic attack. I was barely able to complete the visit. The patient was kind and understanding, but I felt inadequate and knew that my patients deserved better. Importantly, I also knew that I deserved better. I reached out again to my immediate leadership team and said plainly that I was struggling and needed help. I was offered statements of support but no concrete actions.  While crying in my office, I searched our hospital's website for possible sources of help. I was lucky enough to come across our Employee Assistance Program and eventually got connected to a therapist. I will never forget the kindness and help she provided. She (correctly) told me that I had suffered an intense trauma and walked me through the next steps, which included meditation, hydration and nutrition, and intense aerobic exercise. She explained that the aerobic exercise (telling me to run as hard as you can with a goal for high heart rate and lots of sweating) can help the brain to heal from trauma and will prevent or diminish the development of posttraumatic stress disorder. I resisted my urge to search on PubMed to ascertain if these were evidence-based solutions and decided to try whatever she suggested. She also helped me accept a 2-week leave from work and find a therapist who specialized in trauma for health care workers. I continued to see a trauma therapist for a year until I felt I had adequately recovered.  Eventually, as is true with most traumas, time itself was the best healer. A few weeks later, when hospital leadership learned of my experience, things started to happen. Security did a walkthrough of the clinic space. Patient relations notified the patient that this type of behavior would not be tolerated. There was a backup plan put into place in the event the patient needed care when I was the only oncologist available (eg, on the in-patient unit). It was not all forward progress, however. I was told no changes needed to be made to the clinic and that we could not keep examination room doors open because of privacy concerns. The provider desk would continue to be in the corner of the room, and the patient would continue to sit between the provider and the door.  This was understandable given the cost to reconfigure rooms and the unfortunate reality with firearms that even being close to a door may not matter. I asked for panic buttons to be installed—I knew these existed in other clinics—but was told this could not happen. When I asked to be scheduled in rooms where my desk could be next to the door, I was offered a single conference room with no examination table and no medical supplies. I usually work out of three rooms on clinic days, so this would not work. I figured this was as good as it would get and elected to move on and suck it up. Fast forward to 2 weeks ago, when I learned that as much as I hoped these traumatic patient interactions would leave health care workers, they never truly do. I was the oncologist for the in-patient unit at our hospital, which is a liminal space of end-stage disease, anxious patients and families, and difficult decisions. The stakes and severity of the patients' situations are high. One patient and her family were furious at their medical situation of rapidly progressive cancer, as well as the hospital parking and layout, the plan of care, and even the cafeteria options. I was the recipient of all their frustration.  As the patient and her family yelled at me for being inept and stupid and not serving their needs, I had the distinct sensation that my spirit was floating away from my body. I was rising toward the ceiling, watching it all play out in front of me, seeing myself from a bird's eye view. I thought, “Wow, I am dissociating.” It was a surprisingly effective tool to Protect me at that moment and one that I now recognize as a normal response to trauma. Once the patient and family got all their anger out and told me to leave the room, I became unsteady and had to hold the banister to stay grounded. To drive home how vulnerable we all are in facing these kinds of threats, I reflected on the job of an oncologist. I give bad news on a regular basis, I control opiate prescriptions, and many of my patients feel their pain is not well controlled, a phenomenon seen across many oncology patients.2 If we think physicians are only murdered in the emergency room or on the psychiatry unit, we are fooling ourselves. Recent changes to concealed carry laws and increasing levels of medical mistrust and anger directed at health care workers in the wake of the COVID-19 pandemic likely will increase all providers' risk of gun violence.  With reflection, I now understand that my experience then was made worse by the lack of informed response by leadership to mitigate my trauma and the lack of efforts to improve safety. We deserve leaders and hospital staff who know immediately what to do when a physician is threatened, including reassigning the patient to a new provider immediately, having hospital administration or patient care services review with the patient the zero tolerance policy to provider threats, and allowing a prompt leave from work to address the trauma response, which is best done immediately after the event not months later or only on request.  We deserve urgent access to therapists and peer support who understand how to process and overcome trauma. Institutions should track threats to providers in real time and make rapid changes to improve safety. As individuals facing a traumatic patient encounter, we cannot afford to wait for the system to catch up to our needs. We can seek our own counseling and professional support while also providing critical support for our peers.3-5 I thought I was the weak one for not being able (even still) to let this death threat be in the past. I realize now that I am brave and strong for asking for help. We deserve safe environments and clinical practices to allow us to do the difficult work of being an oncologist without worrying about our personal safety. Together we can create clinics, hospitals, and teams that prioritize provider safety and proactively work to mitigate the trauma of patients and families who threaten their physicians and providers.  Dr. Lidia Schapira: Hello and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I'm your host, Dr. Lidia Schapira, associate Editor for Art of Oncology and a professor of medicine at Stanford University. Today we are joined by Dr. Noelle LoConte, associate professor of Medicine at the University of Wisconsin School of Medicine and Public Health. In this episode, we will be discussing her Art of Oncology article ‘I Want to Kill You'.  Our guest disclosures will be linked in the transcript.  Noelle, welcome to our podcast. Thank you for joining us.  Dr. Noelle LoConte: You're welcome. Thanks for having me.  Dr. Lidia Schapira: It's our pleasure.  Dr. Lidia Schapira: I like to start the conversation by asking authors what it is that they're reading or what book they would recommend to a friend.  Dr. Noelle LoConte: Oh, that's a good one. I'm reading a book called Hell of a Book right now. Highly, highly recommend it. It's phenomenal. And a book that I would recommend that I recently read - well, Pachinko is a book that I read last year, but I just can't stop thinking about it. So I think that would be my recommendation.  Dr. Lidia Schapira: So good fiction is a wonderful way of releasing stress after a hard day at work.  Dr. Noelle LoConte: Truly.  Dr. Lidia Schapira: Can you talk a little bit about what made you write this particular piece? Are you somebody who likes to write to process experiences, or was this a particular message that you needed to convey?  Dr. Noelle LoConte: Yeah, I used to journal quite regularly, but gave that up when I started residency and haven't really picked it back up. But this story kind of wrote itself for me. I felt compelled. I could not stop thinking about it, and eventually, I had to do it.  Dr. Lidia Schapira: Reading it is very impactful. And you start with this amazing line, "My patient threatened to kill me." So you're telling us immediately what happened. And the story is quite awful, and I don't know if I should ask you to tell us a little bit about it, but just for the sake of bringing the listeners into the story, can you very quickly recap what happened and how that made you feel? Dr. Noelle LoConte: Yeah, the quick version is I had a long-standing patient in Oncology who I had an established relationship with, who had no red flags for me, who was getting the news of a recurrence, and in response to that news, gave me what I thought was a credible threat to kill me. And the story is about sort of what happened after that, the ripple effect even years later, and how the response of my boss, my health system, my colleagues maybe amplified or made it worse. And then what really compelled me to write this story was when there was a physician that was murdered by a patient, I think not an oncologist, but I just felt the circle sort of tightening in that eventually we're all going to have to think about this. And so that's really what pushed me to write it.  Dr. Lidia Schapira: Yes, and we're grateful for you bringing it to our attention. Let's just start by reflecting on this relationship you had with a patient. You opened the essay by saying that you seemed to trust each other, that you were delighted to see her name on the schedule, that she knew about you, that you had shared freely about your life. And then this threat comes out of nowhere. You didn't anticipate it, and it also comes at a time when there were very few people around because it's a holiday. So tell us a little bit about how you felt in that moment. You basically wanted to make a quick exit from the room, and that comes across, but can you tell us a little bit about what the feelings were that you experienced at the time?  Dr. Noelle LoConte: Immediately, I felt terrified because whether she intended to or not, I believed her that she had a firearm and was going to kill me. The story goes into why I felt that way, but suffice to say; I couldn't sort of intellectualize my way out of this one. I really, deep in my heart, felt panicked. I think after the fact after I got out of the room and got through that day of clinic, I felt ashamed. I think that was probably the emotion I felt, that I fell for it, so to speak, that I didn't just trust that everything was going to be fine.  Dr. Lidia Schapira: Can we talk a little bit more about that shame? I think that is such an important feeling that many physicians share an experience at some point and often doesn't get talked about. How long did it take you to understand that it was perhaps some shame that you were also feeling and perhaps that that was also isolating and compounding the trauma?  Dr. Noelle LoConte: I would say I felt ashamed because I got back to the workroom, and I had to ask for help. I'm of a generation of physician before work hour restrictions and caps and so forth, where I worked many a day, totally sick. I don't think I had ever called in sick to that point. I'm not saying that to say that's the right approach. I, in fact, do not think that's the right approach, but that's the type of physician that I am and how I grew up. I'm also from the upper Midwest, where work ethic really is like the most important personal characteristic, so I take my work pretty seriously. So I felt I had let myself down, I'd let my team down, I had let my patients down, that if I had been a “better physician,” that this wouldn't have gotten to me the way it did. So I would say I felt shame almost immediately. It's been the letting go of the shame that has taken a lot longer. Dr. Lidia Schapira: Talk to us a little bit about the process of letting go of the shame. You mentioned very specifically some activities that helped, finding a therapist that helped, taking time away from work that helped. But walk us through that process.  Dr. Noelle LoConte: Yeah, and I think part of the story, too, is that I kind of bumbled into this, and it would have been better for people above me or supporting me to be like, “You need to do X-Y-Z.” And ultimately, it was when I landed with Primary Care that they were like, “Oh yeah, we get threatened all the time. Here's how we do it.” But yeah, what I did was I used employee assistance program, and then they connected me with a trained therapist who worked with providers that have been threatened - so unfortunately, a growing population for her - and I just in that moment decided to set aside my need to kind of be evidence-based and intellectualize my way out of everything, and I said I am just going to trust that whatever they tell me is sound, and no matter how ‘woo' it sounds to me, I'm just going to do it. Because, at the time, I wasn't sleeping at all. At this point, it had been days, I think since I had slept. And she talked about hydration, nutrition, exercising to really get your heart pumping, get really sweaty, having a safety plan, not being alone. And so I just really just said, ‘I'm just going to do it.'. And then, ultimately, it's really time away from the incident. I mean, it still has not left me, but it is much better.  Dr. Lidia Schapira: Can you share with us a little bit how this impacted your life away from work, at home, how it impacted your relationship with your kids, with your peers, and with people you interact with outside of medicine?  Dr. Noelle LoConte: Yeah, I mean, the most immediate thing was that, unfortunately, there was an active shooter alert that happened shortly after my incident. And I was at home with my kids, and in the moment, I thought I was going to die, and I thought my kids were going to be left without a mother. So, my kids, I wanted to keep them safe from harm, and so I had real moments of thinking like, I should leave my job. It's not worth it. As far as my husband, he's also a physician, and so he implicitly understood.  Dr. Lidia Schapira: I'm glad you had the support that you needed. But you talk a little bit about the lasting trauma, and in the article, you mentioned that what led you to write about this was that there was a trigger that occurred. Can you share a little bit about that? And not only what the triggering incident was, but how do you continue to deal with sort of this ripple effect of what happened now several years ago?  Dr. Noelle LoConte: Yeah, the triggering event for me was I was up on our inpatient unit. So I'm an academic oncologist, we have an inpatient oncology unit. At the time, it was staffed by medical oncologists, we do a week at a time. Now it's shared with the hospitalist, which is wonderful. Actually, it's a great model. But I was the medical oncologist up there, and so you get whatever comes in the door for that week, and there was a patient who was angry and frustrated and had a very bad cancer and the recipe for possible aggressive behavior. And so we were rounding, and I was in the room, and she started yelling at me, and her mother started yelling at me about parking and the food in the cafeteria and when her CAT scan was going to happen - things I have zero control over. But I'm used to– I think all oncologists are used to kind of being the receptacle for people's feelings about an out-of-control situation. At least they can control their conversations with us.  So in the moment, I was like, “Okay, she's not really mad at me, she's mad at the situation, and I'm just going to let her get this out.” But what happened was it brought me right back to that room with my patient, and I dissociated for the first, and I think maybe the only time in my life where I physically could feel myself, like, leaving my body. It was very unsettling for me in the moment, and I had to kind of back up against the wall and ground myself. I realize now what I was doing. But yeah, so that happened. And then that same day, I think, was the day that the orthopedic surgeon got killed. And so I was just like, ‘What is going on?' There's so much gun stuff right now that it's just impossible to be like, “Well, I'm never going to think about this again,” because it's in your face all the time.  Dr. Lidia Schapira: I'm so sorry this happened to you. And again, on behalf of all of our readers, we're grateful that you took the time to share the experience with us.  So thinking a little bit about how we can respond to colleagues and how we can perhaps prevent some of these consequences of violent threats or acts of violence, what have you learned, Noelle? How should organizations respond? What do we need? What can we expect?  Dr. Noelle LoConte: Yeah, I think if you're in a leadership position over a clinic, over a group of providers, including physicians, NPs, APPs of any variety, learners, medical students, residents, fellows, you need to know at a moment's notice what to do if that person is traumatized. And I would include threats of violence in that trauma. Ultimately, it was sort of a game of hot potato with me, and nobody really knew, and they were looking into it, and it's really time sensitive. So I would say if you're a leader, know what to do and know it immediately. I think the other thing is, if you're a male, know that this happens to your female colleagues and non-binary colleagues much more. One of the strategies is to transfer the patient to a male provider. I think hospital security could have been more responsive to my concerns. So in my workspace, and it continues to this day, the provider's in the corner of the room, so you have to walk past. I think we could take some cues from psychiatry and emergency medicine, having things like panic buttons, easy exit for providers, security walk-throughs. Dr. Lidia Schapira: It saddens me to think that we need to think about it and plan for it in a way because we talk so much and train so much for establishing trusting relationships with our patients, and what you're saying is, basically, we can't take anything for granted, even in the context of what appears to be a functioning longitudinal relationship. And that's a scary thought. How do you go to clinic every day and think that this might happen again when you walk into a room?  Dr. Noelle LoConte: I mean, I'd be lying if I didn't say I sort of compartmentalize it, right? I am much more cautious about what I share with my patients about my family. I always kind of take a scan of the room when I'm entering right now and kind of know my surroundings a little bit better, I would say. And I don't assume, I think before this, I had assumed if they have brain mets, if they have a history of a psychotic mental illness, something like that, that I would be more concerned. I'm sort of always aware that this could happen. I think advocating for things like metal detectors, hospital security are all good things too, and I have much less tolerance for being the punching bag, I would say right now. So when people get angry, I just say, ‘I'm leaving the room. When you've calmed down, I'm happy to come back. Here's how to get a hold of me.' And that's all just self-preservation. That's not because I think patients are bad for being angry. I would probably be angry too, but I need to have clear boundaries about what I can and cannot do.  Dr. Lidia Schapira: How do you think this experience has changed you? And do you think that your colleagues and your patients appreciate the change?  Dr. Noelle LoConte: I think it's made me less open. It's definitely made me not want to have super close relationships with patients anymore. Less trusting. I mean, I know that my colleagues happily covered my clinic, but I know there are also hospitals where that wouldn't happen. I'm eternally grateful to those few weeks where they let me take a breather because that's when I realized I really love patient care, and I missed it. I don't know if everybody loves the new me, but I don't know that we had a choice.  Dr. Lidia Schapira: Do you think this is, in part, a gendered conversation? You mentioned that it's more likely to happen to women. Can you expand a little bit on that for listeners?  Dr. Noelle LoConte: Well, when you go to the literature, which of course, being an academic oncologist, was my first response, this happens all the time in emergency medicine and psychiatry. Much more common against women, I'll say providers, but physicians in particular. So yes, it is absolutely a gendered conversation. I think the expectation when we walk in the room is a different expectation about how relational we're going to be, how caring and compassionate. It's not just enough to be competent and intelligent. You also have to be motherly and loving and all this. So, yes, I absolutely think it's a gender conversation for sure. For sure.  Dr. Lidia Schapira: Are there any texts or papers that have been particularly helpful to you or stood out to you that you would recommend to others?  Dr. Noelle LoConte: There was a series, I believe, in emergency medicine literature. I can circle back to you guys and get you the exact reference, but I found their strategies for dealing with aggressive patients very helpful. And I actually found talking to my nursing friends and colleagues was really helpful because they are really experts in de-escalation. So I really rely on them to kind of get language that makes sense coming out of my mouth like that whole, “I'm going to come back when you stop being angry.” So I would say more than any individual article, it was talking to nurses. Dr. Lidia Schapira: I imagine a simulation exercise could be helpful as well for all of us, right? Especially those of us who may be more at risk or have the sort of open, sincere approach to patient care as if we can trust everybody, and perhaps we can. We're very glad that you shared what you were able to share.  Dr. Noelle LoConte: Thank you. Dr. Lidia Schapira: That you brought attention to this very important topic to our community, and I'm sure you've already had responses from colleagues. We've certainly heard from a lot of people who really appreciate your honesty and bringing this story forward and have unfortunately heard similar stories from colleagues.  Dr. Noelle LoConte: Yeah, I think it's pretty common. Dr. Lidia Schapira: So good luck, read well, play a lot, exercise your brains out until your heart rate is in the stratosphere. And thank you. Thank you for sending it. Thank you for sharing it. I know it's been very difficult.  Dr. Noelle LoConte: You're very welcome. Thank you for reading it.  Dr. Lidia Schapira: Until next time. Thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review, and be sure to subscribe, so you never miss an episode. You can find all of the ASCO shows at asco.org/podcasts.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  Like, share and subscribe so you never miss an episode and leave a rating or review.  Guest Bio:  Dr. Noelle LoConte is an associate professor of Medicine at the University of Wisconsin School of Medicine and Public Health.  Additional Reading:  1.         Richardson SK, Ardagh MW, Morrison R, Grainger PC. Management of the aggressive emergency department patient: non-pharmacological perspectives and evidence base. Open Access Emerg Med. 2019 Nov 12;11:271-290. doi: 10.2147/OAEM.S192884. PMID: 31814780; PMCID: PMC6861170.   2.         Incivility in Health Care: Strategies for De-escalating Troubling Encounters      

Gloria speaks with Dr. Laura Masur, an assistant professor in the department of anthropology at The Catholic University of America. Dr. Masur has been one of the archeologists excavating enslaved communities on former plantations owned by the Society of Jesus in Maryland. They ask if and how we can reconcile the early American missionary work, especially of the Jesuits, with the grave sin of slavery. Learn more about your ad choices. Visit megaphone.fm/adchoices

What is it like to be the first person in your family to be the first of everything? The first to attend college, the first to earn multiple advanced degrees, the first to be elected president of a regional professional association? In this episode Dr. Soraira Urquiza talks about her higher education and career journeys, highlighting the specific challenges first generation students encounter. We also discuss resources institutions should provide for first gen students and ways to ensure the students who need them are aware of them. Key Takeaways:First generation students have different support needs than students whose families have more experience navigating the college environment. And they may not even be aware that they have those needs until they're in educational trouble. Institutions need to be proactive with outreach and be persistent with follow-up.Administrators should review their policies, websites, and communications, through the lens of a first generation student (or even work with actual first generation students in this effort!) to make sure that they are clear and communicate the anticipated message.If you work as a registrar for 16 years and serve as the president of a regional association, you're always going to be welcome in the AACRAO family, even if you move on to your dream job of teaching at a community college. And the universe will remind you of this in ways you couldn't imagine. 

I flew out to Chicago to interview Brett Harrison, who is the former President of FTX US President and founder of Architect.In his first longform interview since the fall of FTX, he speak in great detail about his entire tenure there and about SBF's dysfunctional leadership. He talks about how the inner circle of Gary Wang, Nishad Singh, and SBF mismanaged the company, controlled the codebase, got distracted by media, and even threatened him for his letter of resignation.In what was my favorite part of the interview, we also discuss his insights about the financial system from his decades of experience in the world's largest HFT firms.And we talk about Brett's new startup, Architect, as well as the general state of crypto post-FTX.After talking with Brett for 3 hours, I found him to be extremely intelligent, thoughtful, and ethical.Watch on YouTube. Listen on Apple Podcasts, Spotify, or any other podcast platform. Read the full transcript here. Follow me on Twitter for updates on future episodes.Similar episodesSide note: Paying the billsTo help pay the bills for my podcast, I've turned on paid subscriptions on Substack.No major content will be paywalled - please don't donate if you have to think twice before buying a cup of coffee.But if you have the means & have enjoyed my podcast, I would appreciate your support

Have faith and science always been enemies? The story of Robert Hooke, a revolutionary working in the Scientific Revolution, exemplifies the ways in which Christianity has actually provoked scientific inquiry.  Robert George, McCormick Professor of Jurisprudence and Director of the James Madison Program in American Ideals and Institutions at Princeton University. Patricia Fara, director of studies and affiliated lecturer at the University of Cambridge's Department of the History and Philosophy of Science. Jim Bennett, Keeper Emeritus at the Science Museum, London and professor emeritus of the history of science, University of Oxford. Brother Guy Consolmagno, director of the Vatican Observatory and president of the Vatican Observatory Foundation. Stephen Barr, professor emeritus at the University of Delaware's department of physics and astronomy. This episode was produced by Rosalind Rei and Maria Devlin McNair. Illuminations is supported by the John Templeton Foundation. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/biography

Have faith and science always been enemies? The story of Robert Hooke, a revolutionary working in the Scientific Revolution, exemplifies the ways in which Christianity has actually provoked scientific inquiry.  Robert George, McCormick Professor of Jurisprudence and Director of the James Madison Program in American Ideals and Institutions at Princeton University. Patricia Fara, director of studies and affiliated lecturer at the University of Cambridge's Department of the History and Philosophy of Science. Jim Bennett, Keeper Emeritus at the Science Museum, London and professor emeritus of the history of science, University of Oxford. Brother Guy Consolmagno, director of the Vatican Observatory and president of the Vatican Observatory Foundation. Stephen Barr, professor emeritus at the University of Delaware's department of physics and astronomy. This episode was produced by Rosalind Rei and Maria Devlin McNair. Illuminations is supported by the John Templeton Foundation. Learn more about your ad choices. Visit megaphone.fm/adchoices

Have faith and science always been enemies? The story of Robert Hooke, a revolutionary working in the Scientific Revolution, exemplifies the ways in which Christianity has actually provoked scientific inquiry.  Robert George, McCormick Professor of Jurisprudence and Director of the James Madison Program in American Ideals and Institutions at Princeton University. Patricia Fara, director of studies and affiliated lecturer at the University of Cambridge's Department of the History and Philosophy of Science. Jim Bennett, Keeper Emeritus at the Science Museum, London and professor emeritus of the history of science, University of Oxford. Brother Guy Consolmagno, director of the Vatican Observatory and president of the Vatican Observatory Foundation. Stephen Barr, professor emeritus at the University of Delaware's department of physics and astronomy. This episode was produced by Rosalind Rei and Maria Devlin McNair. Illuminations is supported by the John Templeton Foundation. Learn more about your ad choices. Visit megaphone.fm/adchoices

Have faith and science always been enemies? The story of Robert Hooke, a revolutionary working in the Scientific Revolution, exemplifies the ways in which Christianity has actually provoked scientific inquiry.  Robert George, McCormick Professor of Jurisprudence and Director of the James Madison Program in American Ideals and Institutions at Princeton University. Patricia Fara, director of studies and affiliated lecturer at the University of Cambridge's Department of the History and Philosophy of Science. Jim Bennett, Keeper Emeritus at the Science Museum, London and professor emeritus of the history of science, University of Oxford. Brother Guy Consolmagno, director of the Vatican Observatory and president of the Vatican Observatory Foundation. Stephen Barr, professor emeritus at the University of Delaware's department of physics and astronomy. This episode was produced by Rosalind Rei and Maria Devlin McNair. Illuminations is supported by the John Templeton Foundation. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/history

Have faith and science always been enemies? The story of Robert Hooke, a revolutionary working in the Scientific Revolution, exemplifies the ways in which Christianity has actually provoked scientific inquiry.  Robert George, McCormick Professor of Jurisprudence and Director of the James Madison Program in American Ideals and Institutions at Princeton University. Patricia Fara, director of studies and affiliated lecturer at the University of Cambridge's Department of the History and Philosophy of Science. Jim Bennett, Keeper Emeritus at the Science Museum, London and professor emeritus of the history of science, University of Oxford. Brother Guy Consolmagno, director of the Vatican Observatory and president of the Vatican Observatory Foundation. Stephen Barr, professor emeritus at the University of Delaware's department of physics and astronomy. This episode was produced by Rosalind Rei and Maria Devlin McNair. Illuminations is supported by the John Templeton Foundation. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

In Episode 227, we talk about all the institutions that are failing in America. Our Patreon supporters share their list of failing institutions - their observations are fascinating. We finish out the list of failing institutions in the After Show, available exclusively to Patreons. Of course we do another hilarious Lightning Round in the After Show available to Patreons - but this time Shelby asks them to Glen. Please support our sponsors ProOne Water Filters, Gibbz Arms, Forever Forward Apparel,  EMP Shield, Paul Burke - Idaho Realtor, Numanna Foods, Backwoods Home Magazine, Jared Savik - Montana Realtor, and Minutemen Coffee. We are part of the Firearms Radio Network. Learn more about our podcast at Prepping 2-0.com.

In Episode 227, we talk about all the institutions that are failing in America. Our Patreon supporters share their list of failing institutions - their observations are fascinating. We finish out the list of failing institutions in the After Show, available exclusively to Patreons. Of course we do another hilarious Lightning Round in the After Show available to Patreons - but this time Shelby asks them to Glen. Please support our sponsors ProOne Water Filters, Gibbz Arms, Forever Forward Apparel,  EMP Shield, Paul Burke - Idaho Realtor, Numanna Foods, Backwoods Home Magazine, Jared Savik - Montana Realtor, and Minutemen Coffee. We are part of the Firearms Radio Network. Learn more about our podcast at Prepping 2-0.com.

Recent guidance has come out recommending children have surgery or go on drugs to lose weight. Why is this a problem and what's the history behind anti-fat politics in America? Katelyn and Oliver sit down with writer, journalist and theorist Da'Shaun Harrison to explore these questions and learn about how anti-fatness is rooted in and inextricable from anti-blackness. Da'Shaun is the author of Belly of the Beast: The Politics of Anti-fatness as Anti-Blackness and Editor-at-Large of Scalawag Magazine. A very special thanks to our Cancellation List and above Patreons Megg, Catherine, Dahlia, I Beauregard, Leslie, Adrienne, Diego, Mae and Siobhan for making this episode possible. You can submit your requests for out of context cancellations, support our work and join our community by visiting www.patreon.com/CancelMeDaddy.

In Episode 227, we talk about all the institutions that are failing in America. Our Patreon supporters share their list of failing institutions - their observations are fascinating. We finish out the list of failing institutions in the After Show, available exclusively to Patreons. Of course we do another hilarious Lightning Round in the After Show available to Patreons - but this time Shelby asks them to Glen. Please support our sponsors ProOne Water Filters, Gibbz Arms, Forever Forward Apparel, EMP Shield, Paul Burke - Idaho Realtor, Numanna Foods, Backwoods Home Magazine, Jared Savik - Montana Realtor, and Minutemen Coffee. We are part of the Firearms Radio Network. Learn more about our podcast at Prepping 2-0.com.

Grace welcomes author and documentary director Vince Everett Ellison to the show to discuss his latest work, "Will You Go to Hell for Me," where he delves into the institutions all around us seeking to eternally damage souls. Then, Grace talks TikTok and how a national ban wouldn't be so bad. Finally, Grace reports the FTC's eyes on Elon with moves to investigate the tech giant.

durée : 00:59:14 - Le Cours de l'histoire - par : Xavier Mauduit - Guildes, confréries ou communautés de métiers, les travailleurs du Moyen Âge s'organisent ! Ces associations de métiers, constituées d'artisans ou de marchands, se rassemblent afin de représenter leurs intérêts communs face au pouvoir royal… - invités : François Rivière Docteur en histoire médiévale, rattaché au Laboratoire de médiévistique occidentale de Paris et au laboratoire Institutions et dynamiques historiques de l'économie et de la société; Julie Claustre Maîtresse de conférences en histoire du Moyen Âge à l'université Paris 1 Panthéon-Sorbonne, spécialiste de l'histoire de la société parisienne

The Regent schools and their "diversity, equity and inclusions" departments are now facing extinction

Dr. Maryam Abdool-Richards C.M. is a specialist in Family Medicine and public health, highly experienced holder of a EMBA; and a key member of the team for the implementation and leadership of the Parallel Health Care System since the advent of the COVID-19 pandemic, being recognized by the US Secretary of State for her leadership in this role.   She was awarded the Chaconia Medal Gold for meritorious service in Public Health Leadership, in September 2022, and is a passionate philanthropist, who led a collaborative effort between the public and private sectors to establish the “Ray of Hope”, an isolation and quarantine treatment centre for Covid-19 positive wards of the state.   Dr. Richards is on “Getting to the Top!” to share her passion for using her practical knowledge and certified expertise to help others. “Getting to the Top!” is available on Apple Podcasts, Audible, Google Podcasts, Spotify, and my YouTube channel. Please Subscribe!  YouTube: https://youtu.be/MdZqkxERtbw   Apple Podcasts https://podcasts.apple.com/us/podcast/getting-to-the-top/id1612120883?i=1000602889655 Audible https://www.audible.com/pd/B0BXKM5G9T?source_code=ASSORAP0511160006&share_location=podcast_episode_detail   Google Podcasts https://podcasts.google.com?feed=aHR0cHM6Ly9hbmNob3IuZm0vcy84NWVkN2FkMC9wb2RjYXN0L3Jzcw%3D%3D&episode=OTM1MWUyYmEtZWJmMy00YzYwLTliOGYtM2MxOTBjOGIzMGFh Spotify https://open.spotify.com/episode/39ErpQt3JEYdTSAaJ6UnaS?si=2JMDCALKQHKakqhzrJkY8Q

Interested in further study of the Bible? Join us at Logos Bible Software. Sign up to attend Westminster Seminary California's Seminary for a Day here! Do you want to retrieve our Classical Protestant theology and heritage? Sign up for a degree program or individual classes at the Davenant Institute by following this link here. Please help support the show on our Patreon Page! WELCOME TO BOOK CLUB! Matthew J. Lynch is associate professor of Old Testament at Regent College in Vancouver, Canada. He is the author of First Isaiah and the Disappearance of the Gods, Portraying Violence in the Hebrew Bible, and Monotheism and Institutions in the Book of Chronicles. He is the co-founder of the OnScript podcast, a podcast focused on providing engaging conversations on Bible and theology. We want to thank IVP for their help in setting up this interview and providing us with the necessary materials for this interview Purchase the book(s) here: Flood and Fury Have Feedback or Questions? Email us at: guiltgracepod@gmail.com Find us on Instagram: @guiltgracepod Follow us on Twitter: @guiltgracepod Find us on YouTube: Guilt Grace Gratitude Podcast Please rate and subscribe to the podcast on whatever platform you use! Looking for a Reformed Church? North American Presbyterian & Reformed Churches --- Support this podcast: https://anchor.fm/gggpodcast/support

Mark Levin. Jesse Kelly. Ukraine and U.S. Military Preparedness. Jesse on Apples. The Left's Long March Through America's Institutions. The Jesse Kelly Show The Truth About Apples. The Long March Through America's Institutions. NY Housing projects.  Feb 27 2023   Visit Jesse Kelly website at https://www.jessekellyshow.com/ Jesse Kelly is highly recommended by ACU. Subscribe for free.   Mark Levin. Ukraine and U.S. Military Preparedness. Mark Levin Podcast The Best Of Mark Levin  Feb 25 2023   This week on the Mark Levin Show, it's amazing that people complain about how much money the U.S is spending in Ukraine, but it's nothing close to the amount of money government wastes on redistribution of wealth and pursing Marxist's agendas. Some say, why is Ukraine our business? Was it our business when Germany invaded Poland in 1939? Ukrainians want their liberty. We should be proud that we are helping to arm Ukraine with weapons. There is no Republican Presidential candidate today, announced, or unannounced, insisting we increase defense spending without footnotes. No one is talking about rebuilding the military in a comprehensive way. Mark Levin is highly recommended by ACU. Mark Levin Podcast. Mark Levin Audio Rewind https://www.marklevinshow.com/audio-rewind/ You can download Mark Levin's podcasts in a number of ways: Subscribe to the podcasts through Apple Podcasts Subscribe to the podcasts through Google Podcasts Subscribe to the podcasts through Stitcher Subscribe to the podcasts through Spotify Subscribe to the podcasts through TuneIn Listen through Amazon Podcasts HELP ACU SPREAD THE WORD!  Please go to Apple Podcasts and give ACU a 5 star rating. Apple canceled us and now we are clawing our way back to the top. Don't let the Leftist win. Do it now! Thanks. Forward this show to friends. Ways to subscribe to the American Conservative University Podcast Click here to subscribe via Apple Podcasts Click here to subscribe via RSS You can also subscribe via Stitcher FM Player Podcast Addict Tune-in Podcasts Pandora Look us up on Amazon Prime …And Many Other Podcast Aggregators and sites   Please help ACU by submitting your Show ideas. Email us at americanconservativeuniversity@americanconservativeuniversity.com Please go to Apple Podcasts and give ACU a 5 star rating. Apple canceled us and now we are clawing our way back to the top. Don't let the Leftist win. Do it now! Thanks.   Endorsed Charities -------------------------------------------------------- Pre-Born! Saving babies and Souls. https://preborn.org/ OUR MISSION To glorify Jesus Christ by leading and equipping pregnancy clinics to save more babies and souls. WHAT WE DO Pre-Born! partners with life-affirming pregnancy clinics all across the nation. We are designed to strategically impact the abortion industry through the following initiatives:… -------------------------------------------------------- Help CSI Stamp Out Slavery In Sudan Join us in our effort to free over 350 slaves. Listeners to the Eric Metaxas Show will remember our annual effort to free Christians who have been enslaved for simply acknowledging Jesus Christ as their Savior. As we celebrate the birth of Christ this Christmas, join us in giving new life to brothers and sisters in Sudan who have enslaved as a result of their faith. https://csi-usa.org/metaxas   https://csi-usa.org/slavery/   Typical Aid for the Enslaved A ration of sorghum, a local nutrient-rich staple food A dairy goat A “Sack of Hope,” a survival kit containing essential items such as tarp for shelter, a cooking pan, a water canister, a mosquito net, a blanket, a handheld sickle, and fishing hooks. Release celebrations include prayer and gathering for a meal, and medical care for those in need. The CSI team provides comfort, encouragement, and a shoulder to lean on while they tell their stories and begin their new lives. Thank you for your compassion  Giving the Gift of Freedom and Hope to the Enslaved South Sudanese --------------------------------------------------------

Kaylee McGhee White reports how "the scientific revolt against gender ideology has begun." Also, a New York teacher is sued for trying to convince a 9-year old student to be transgender.  Get exclusive content here!: https://thepetekalinershow.com/See omnystudio.com/listener for privacy information.

Join Victor Davis Hanson and cohost Jack Fowler as they discuss Jimmy Carter's life and legacy, destroying meritocracy in our institutions, and thoughts on how Ron DeSantis should shape his campaign agenda.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In honor of Black history month, Cornel West and Robert George join the Gloria Purvis Podcast to talk about what Black joy and resistance mean to them. West and George are currently touring the country to speak at various universities about the centrality of truth-seeking to higher education. They are both prolific intellectual giants, who require very little introduction, but whose friendship is an inspiration. Dr. Cornel West teaches on the works of Dietrich Bonhoeffer, as well as courses in Philosophy of Religion, African American Critical Thought, and a wide range of subjects at Union Theological Seminary. He has written 20 books and is best known for his classics, Race Matters and Democracy Matters, and for his memoir, Brother West: Living and Loving Out Loud. His most recent book, Black Prophetic Fire, offers an unflinching look at nineteenth and twentieth-century African American leaders and their visionary legacies. Robert George is a professor of Jurisprudence and the Director of the James Madison Program in American Ideals and Institutions at Princeton University, a program founded under his leadership in 2000. He has served as Chairman of the U.S. Commission on International Religious Freedom as well as a presidential appointee of the U.S. Commission on Civil Rights and the President's Council on Bioethics. In addition, Professor George has served as the U.S. member of UNESCO's World Commission on the Ethics of Scientific Knowledge and Technology. He was also a Judicial Fellow at the Supreme Court of the United States, and the author of several books.  Learn more about your ad choices. Visit megaphone.fm/adchoices

The most revealing moment of Jesse's life shows the difference between what people want to believe versus what the reality of the situation is. Removing the American flag from military vehicles. The Long March Through America's Institutions. NY Housing projects. See omnystudio.com/listener for privacy information.

On this week's episode, Dr. Arun Seraphin is joined by Evelyn Kent, Program Director, Historically Black Colleges and Universities and Minority-serving Institutions, Office of the Under Secretary of Defense for Research and Engineering. Join us for a conversation about how the Pentagon works with HBCUs and is accelerating efforts to connect these colleges and other minority institutions to defense industry and DOD research activities.

The 20th anniversary of the launch of the U.S.-led invasion of Iraq approaches next month. Within weeks, Iraq plunged into insurgency and sectarian warfare as competing factions battled for control of the country. Institutions established then still remain in place today; how effective are they? Looking back, what did American policy get right and wrong? What insights does a look back provide for today's problems?

The American communists have taken a long march through the institutions and captured many important aspects of American life. Whether it's education, the media, entertainment, medicine, you name it... Which institutions are most corrupted, and which will have the biggest impact on America going forward? Those are the questions Jesse Kelly and his panel of experts answer on this special.     See omnystudio.com/listener for privacy information.

During this podcast, listeners will hear perspectives from key players required to create and maintain meaningful collaborations between colleges of pharmacy and health-system institutions. Successes and challenges, and tips for successful collaboration will be discussed. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

Advanced practice providers (APPs) are a key component to effective team-based care, but what is it that our APP team-members can do in an oncology practice? Join the Co-hosts of the APP podcast series, Todd Pickard (MD Anderson Cancer Center) and Stephanie Williams (Northwestern University Feinberg School of Medicine), along with guests Wendy Vogel (BroadcastMed/APSHO)) and Tammy Triglianos (University of North Carolina Basnight Cancer Hospital), as they highlight the services and examples of what APPs in oncology can do, their role as an APP in team-based care, if and how they bill for their services, and how they are reimbursed.  Speaker Disclosures: Stephanie Williams: Consultant or Advisory Role – CVS Caremark Tammy Triglianos: Consulting or Advisory Role – Pfizer Todd Pickard: No relationships to disclose Wendy Vogel: No relationships to disclose  Resources: Podcast: Advanced Practice Providers - APPs 101: What and Who Are Advanced Practice Providers (APPs)? Podcast: Advanced Practice Providers – An APP's Scope of Practice Advanced Practice Providers - APPs 101: Physicians Assistants (PAs) and Advanced Practice Registered Nurses (APRNS) in Oncology If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT The disclosures for guests on this podcast can be found in the show notes. Dr. Stephanie Williams: Hello, everyone, and welcome back to the ASCO Education podcast, and our fourth episode of the Advanced Practice Providers series. I'm Dr. Stephanie Williams, a medical oncologist, and your co-host for the series, along with physician assistant Todd Pickard. We'd also like to introduce you to our guest panelists today. Returning guest, Wendy Vogel, along with Tammy Triglianos. We'll take a moment to let them introduce themselves, starting with Wendy. Wendy Vogel: Hi. Thanks so much for having me today. I'm Wendy Vogel. I'm an oncology nurse practitioner by trade, and I am the Executive Director of APSHO, the Advanced Practitioner Society for Hematology and Oncology. And thanks for having me here today. I'm really excited to be here.  Dr. Stephanie Williams: Tammy.  Tammy Triglianos: Hi, everyone. Thank you for having me. And I'm excited to join this group for our conversation today. I'm Tammy Triglianos. I am a certified oncology nurse practitioner practicing in North Carolina. My career has been dedicated to caring for oncology patients, even starting out as a nursing assistant and then as a registered nurse practicing in a variety of settings. I've been a nurse practitioner for almost 20 years now, with the past 15 specializing in GI medical oncology.  Dr. Stephanie Williams: Thank you.  Todd Pickard: Thanks, everybody, for being here today.  Dr. Stephanie Williams: In today's episode, we will be highlighting the services and examples of what advanced practice providers in oncology can do and describing if and how they bill for their services and how they are reimbursed.  So let's get started. Wendy and Tammy, I'm starting in my clinic, 8:30 in the morning. We have a full panel of patients, patients who just need reassessment, chemotherapy prescribed, reevaluation, bone marrow biopsies, test results. How do we work together to see, as a team, these particular patients, or in other words, what can you do to help me through my days as an oncology practitioner?  Wendy Vogel: Wow, that's a great question to just jump right in and start with. I'm excited to talk about that. Well, I think that, you know, as we always are talking about our team approach, we would look at that schedule. And hopefully, the AP and you have their own schedule so that we're able to divide and conquer and be able to accomplish that schedule, see all the patients in the most efficient manner possible. Hopefully, I've looked at all my patients beforehand and see if there's anything that I need to collaborate with you on. Looking at our labs, you know, maybe scans, talking about any changes in plans that we might anticipate together, and so on.   Tammy, would you do the same?  Tammy Triglianos: Yeah, I'd like to echo your point, Wendy. Having independent schedules, I think, makes for a more efficient workflow in the clinic. And in my practice we have a team meeting with our clinical pharmacist, physician, myself, and our nurse navigator, and review last week's and even prep for the upcoming week, trying to anticipate and make sure people are set up and orders are in, and we're prepared for the week to come. Day of, as you know, can get pretty hectic. But since we've done a lot of that prep work, I think it makes for the unknowns that pop up in clinic easier to connect with each other, with my physician and other team members.  Todd Pickard: I agree. I think the great thing about how physicians and APPs work in teams is that the team can decide what's best. I have done everything from having my own independent template so that I have patients that I'm responsible for to a general template where the physician and I just divide and conquer at the beginning of clinic, and we say, “Okay, you see these patients, I'll see these patients, and we'll back each other up if we need to.” All the way to seeing every single patient along with the physician when we are seeing a lot of news and consults, very complex, very acutely ill patients. And we basically just work as a team the entire day on everything.  So it's really interesting about the conversation that I think we'll end up doing today is the “what” versus “how.” What APPs do is– really, honestly, APPs can do anything and everything unless a state scope of practice or an institution's policy specifically says they can't. That's the good news is that we pretty much can do everything but the “how,” that's a really interesting question because a lot of different things come into play. Position preferences, which could be influenced by their own personal experience or their own personal preferences of style versus, you know, having a misunderstanding of what APPs can and can't do. Then there's the institutional policies and the state scope of practices that come into play. So I think this where we'll end up spending some time today.  And, you know, Stephanie, maybe we could start the conversation with you a little bit around physician preferences and what your experience has been, and some of the things that you've noted around the physicians as part of this team.  Dr. Stephanie Williams: I've worked with APPs, both inpatient and outpatient, and I think it is very important to have that team-based approach. Patients really appreciate that, knowing that there is always a provider, someone there that they can turn to. And I think that's one of the great things about APPs is they always seem to be there for patients to turn to and for our nurses to turn to, to get help too. Both our clinic nurses, our infusion nurses, and our inpatient nurses really appreciate having that extra clinical provider available to them. I think as a physician, during my day, what I would like to see is us getting through our panels of patients, whether we're together, which is not as efficient as if we're independently seeing patients, but also help with things like procedures that need to be done on patients, phone calls at the end of the day, peer-to-peer reviews in order to get either medications or tests done for our particular patients. Filling out forms, no one likes doing that. No one likes filling out disability forms or other insurance forms, but those are all things that we all need help with in terms of doing. Ordering consults, seeing new patients together. I work in the transplant field, so they're complicated patients, so it actually is very helpful to have, to see a patient with your advanced practice provider so that you can come up with a treatment plan together that you know you can then follow throughout the course of hopefully that patient's treatment and recovery. Chemotherapy orders is another place that we need, that can be very valuable, whether it's the initial chemotherapy order, which were usually the physician or pharmacist initiated, but those follow-up chemotherapy appointments or problems in the infusion clinic are also helpful areas.  There are some physicians, though, who want to have an APP simply as their scribe, to follow them around in clinic and to then begin whatever orders they feel is appropriate for that particular patient. That is not the most efficient way to see patients, particularly when you have a large panel of patients that you have to see.  Wendy Vogel: Exactly. It really isn't. I will just tag off something you said about the AP being the scribe. That's probably one of the most expensive scribes that a physician could employ, and what a better use of our time is to not be a scribe. You know, there are other people who could really efficiently be a scribe better than the AP, and the AP could actually be seeing patients and gaining reimbursement for the practice.  Tammy Triglianos: An additional comment on team-based care. I work with a physician where we alternate visits, and I think that has really worked well in establishing a relationship with patients. We both have very high touch points with the patients, very involved, and patients feel like there's that team that's always available because always one of us is usually available. Dr. Stephanie Williams: How long did it take you all, all three of you, to develop that relationship with your physician colleagues to work tightly in a team? Todd Pickard: That's really a great question, Stephanie, because I think one of the strengths of the relationship is that level of trust and comfort and not really to view it as a hierarchical relationship, but really a team. We're there for each other. And you know, that depends, you know, there's personalities involved, people's previous experience, you know. If you've only had great experiences with APPs, probably trust them right away. If you've had difficult relationships with APPs or teams that didn't work well, it may take longer. I'd say the best approach is for both the APP and the physician to really look at this as, “How can we accomplish our work together that provides the best quality and the highest level of safety for our patients?” And really just set the expectations of ‘this is a trusting relationship where we work together, we support each other, and we're willing to talk about where the limits of our knowledge are. And for both of us, that's when we get consultations with other folks, and so we just approach it from this perspective.' And of course, you know,over time, that just strengthens and grows. And when you have a really good, strong, trusting relationship, that's where the real power of the team comes into play. Wendy Vogel: I like what you said about trusting. You know, the AP has to trust in the physician to be able to go and ask questions and to be mentored, and vice versa, too. I think we play to each other's strengths. If my strength is talking about hospice to a patient that needs to change trajectory of course, then maybe that's what I do better. And there are other things that another team member would do better, but feeling comfortable and saying, “You know, this is what I do good,” or, “Hey, I need help with this. I don't do this as well as I would like to.” Dr. Stephanie Williams: Tammy, anything? You said you work with one physician. How did that develop?  Tammy Triglianos: Right now, that's my current setup because of volumes, but I have worked with a team of physicians as well, which, when you're an APP working with a team of three, four plus physicians, that can kind of get a little bit tricky, people fighting for your time. I think being in parallel clinics has helped establish our trusting relationship because all day long, you're with that person navigating care together. We've been together probably 14 years, so that's really dipping back into my memory bank of the beginning of our time together. But I think it's what Wendy was talking about is just approaching each other with questions or, “Hey, why did you do that?” Or “Help me understand this.” And I think our approach to each other wasn't, “Why did you do that?” But, “Help me understand your thoughts on this.” Or “Can I talk through this with you to make sure I'm on the right page.” And how that response came back, then I think that has helped develop a trusting relationship.  Dr. Stephanie Williams: You both bring up excellent points because there still exists that power gradient between the physician, the advanced practice provider, and a staff nurse or an infusion nurse. And it's really important to overcome that so that people are comfortable in terms of taking care of the patient, to give the patient the best possible care that there is. Todd Pickard: Yeah, I mean, I think this is a great time to really just highlight the fact that there's a lot of misinformation and misunderstanding out there around APPs, what they can, what they can't do, what they will, what they won't do. In some corners, there's this fear that APPs will go rogue, and that will harm patients. And really, that is an irrational fear because when we are trained, we are trained very clearly about when you reach your own limits, that you are required and obligated as part of your professional practice to find that support, find those resources, get consultations, work with your team to understand so that you serve the patient. And I think it's really important that folks remember that with this respect and trust and accountability, because asking for help is not a failure. Asking for help shows a successful dynamic within a team so that the entirety of the team brings to bear their expertise, their knowledge, their skills, and their judgment. And when the team doesn't know what to do, that's when you've got to reach out to your consults and your other resources. So I think that's an important thing to remind everybody is that we're all here trying to do the same work, and it doesn't do any good if you spend a lot of time wondering, “What's Todd up to today?” So I think it's important to realize and for us to kind of dispel those kinds of myths. Wendy Vogel: I think, despite a social media post by one of our well-known medical associations that will remain unnamed, we don't think that healthcare is a game. We are absolutely serious about this, and we love taking care of our oncology patients. This is something that we're trained to do and that we want to work together as a team. Great thoughts, Todd. Dr. Stephanie Williams: In terms of actual practice in the states that you're at, are there any restrictions, either statewide, institution-wise, on what you can and can't do? Tammy Triglianos: I think a big topic that comes up a lot is signing treatment plans or antineoplastic treatment plans. And I don't know across the states, but in my state, that is not a state restriction. But not allowing APPs to sign antineoplastic treatment plans is more of an institutional restriction, and that varies. Recently, I was able to work with a team of people to update our policy to allow APPs to sign antineoplastic treatment plans and how it works at my institution, they go through a privileging process, so essentially it's an opt-in privilege. So, APPs can obtain approval to sign treatment plans, and it is restricted to cycle two and after. So the treatment plan initiation and signing the first cycle is done by the physician, and APP can place the treatment plan and get it teed up. But it actually is signed by a physician for cycle one, and then an APP is now allowed to sign beyond cycle one. We have a few guidelines like they have to be in their subspecialty practice and be manipulating treatment plans that are cosigned by the physician initially and have certain subspecialty training. So, yeah, I'm excited about this update to allow APPs to practice to the top of their license.  Todd Pickard: Stephanie, this is such an important concept and one that we have hit upon in all of our podcasts. And really, the limits of APPs outside of physician preferences are really state laws and institutional policies. And so, the answer to your question is ‘yes, and it depends on where you are'. So, for example– Tammy gave an example of what's going on in her institution. In my institution, all chemotherapy plans must have a double signature, whether it's initiated by a physician or a pharmacist, or an APP, and that's a safety and quality check. And so everybody just needs to understand, again, limits generally are only in state laws and institutional policies rather than what APPs are trained to do or what folks will reimburse for. And so, really, that's where you have to do the most detailed examination is: what state are you in and what does your institution or your practice say? Generally speaking, most states allow teams at the local level to kind of figure out what they want to do. Sometimes they'll limit a certain medication, like a schedule II drug or a certain other medication. Institutions sometimes do the same thing. But the good news is, if it's not explicit in state law, you can change institutional policy and physician preference all day long.  Wendy, what's your experience been?  Wendy Vogel: Oh, I totally agree. I think it's important for APs to know who's setting the institutional policies and for physicians to know this as well because it may be someone who is not familiar with what the AP role could really be. What do they know about the advanced practitioner? We mentioned that earlier. But I think it also brings up a very important gap that we've seen in oncology, is what's the training of the AP to be able to write anti-cancer therapy orders, and it's a wide variety. There are very few, for instance, nurse practitioner oncology certification or graduate programs. Most of us are trained in a generalist level as a family nurse practitioner. PAs, as you said before on this podcast, you are trained at a generalist level, and we get a lot of our specialty education on the job or through other advanced education. So we're coming into this at all different levels: brand new APs, brand new to oncology APs, and we've seen a gap at the educational level across the US is not the same.  One of the things that APSHO has done to relieve this, and I'm so excited to be able to share with you guys, is we've just recently launched the APSHO Cancer Therapy Prescribing Course. This, I think, will set the benchmark that we've just talked about and bridge this gap, and allow APs to really practice to the top of their licensure, as Tammy mentioned earlier. It's a very comprehensive online, self-paced course providing that advanced education to prescribe cancer therapies and to manage that hem/onc patient throughout the treatment trajectory. It does not just include the cancer therapies but other things we need to know as APs, like: what kind of drugs do we give with the cancer therapies, what are the standards of care, what do we do in clinical trials? And so just all this that we need to know, and I hope this will bridge that gap, if you will, for this education.  Dr. Stephanie Williams: Excellent points. I think it also requires physician education to know and understand what advanced practice providers can do. And I think an advantage to our younger generation physicians is that they are now growing up in institutions where APPs are normal, as opposed to older physicians like myself, where we really do have to learn what can be done and what can't be done so that we can trust what everyone is doing there. Todd Pickard: Are we normal? Yes. But what you really mean is that we're present. It's really about interprofessional education, and I think there's a lot of importance of that concept. If we're going to be delivering care in teams, we should be trained in teams so that you grow up side by side and so that way it does seem normal. I'm working in a team; where's the social worker? Where's the APP? You know, where's the pharmacist? Because that's how you trained, and that's how we really deliver care. That's the honest truth. No man or no woman is an island in medicine. We all work in teams, whether we recognize that or not. And so I think it's great when you hear about folks that are actually training side by side because it just dispels some of this anxiety, some of these misconceptions, and you're just used to the team being around, and it's like, “Okay, where's my team?” And then it doesn't become unusual. It's just normal. Wendy Vogel: Yeah, we're all sitting here nodding our heads together. You all can't see us, but we're all nodding. So, Stephanie, I really want to know, how do you educate your colleagues who might not be as receptive to the idea of an advanced practitioner writing cancer therapy orders? Dr. Stephanie Williams: I have to tell you, it's difficult sometimes, Wendy, or it has been difficult in the past. The problem becomes not so much a “do you know what you're doing,” problem is how does the reimbursement - I hate to say this – how does reimbursement figure into all this? If I let an APP see half of my patients, who gets that money? And then the other thing is just how do I efficiently use an APP? And we are trying, and  ASCO through the Clinical Practice Committee, to try to get out there and reach out to practices, particularly rural practices, to help them understand the role and the value of advanced practice providers. And I think it's going to be a reach-out effort, leading by example, showing people that this is the way we can do it and we have to do it this way because we need practitioners out there to take care of patients. Todd Pickard: I want us to all pause here because what you just talked about is critically important. And we all know this is part of medicine, whether we like it or not. But reimbursement, how we get paid, and productivity, how we are recognized for what we do, are concepts that sometimes get mixed up. So when you're talking about reimbursement, APPs are reimbursed just like physicians for everything that we do. Depending on who's paying the bill, they may reduce that reimbursement. So CMS reduces generally to 85% of the physician fees. Medicaid is all over the place, depending on your state and the third-party payers, like the commercial insurance, that's based on whatever you've negotiated in your contract. Sometimes it's a little, and sometimes it's the same. So APPs get reimbursed, period. What level they get reimbursed compared to the physician's reimbursement is really up to a lot of different factors.  But productivity, I think that's the thing that we really get hung up on is, well,who's going to get credit for this work? And guess what? The beauty of that is you get to decide. Every practice, every institution makes up those rules. And so, you know, the take-home message here is, don't confuse reimbursement with productivity. Reimbursement is a lot of external factors that are either statutory, or they're contractually negotiated. But productivity is an internal accounting, and you can use team-based metrics. Who's to stop you from saying ‘we reward and recognize both the physician and the APP in these teams.' They both get credit, and they both get productivity measurements and recognition. And so I think that's where we really need to drive home the message is it's not about setting each other up as competitors. It's redesigning our internal productivity measures so that it's collaborative and that all the work that's being done by the entire team is being recognized and rewarded. Wendy Vogel: A lot of what we do, as Stephanie referred to earlier, is not reimbursable. All those peer-to-peer reviews, we don't get paid for that. None of us do. Calling patients back, liaisoning with the nursing staff, and answering their questions through the triage line, so much of that is vital to supporting a practice, and you can't do it without all that, but it doesn't appear on the bean counter's metric sheet. So how do we do that? I don't have the answer to that. Tammy Triglianos: Yeah, and I think in oncology/hematology, there's a lot of frequent touch points in between provider visits, and that doesn't equate to money, but equates to high-quality care, to have access to skilled providers to help manage all the complications, and, you know,in between stuff that happens between provider visits. Dr. Stephanie Williams: Wendy, there have been changes now in terms of who can enroll and write treatment orders for patients on cancer clinical trials. Could you go over those changes with us and how APPs can now fully participate in this process? Wendy Vogel: So there were some recent changes to CTEP and then now allowing APs to sign clinical trial orders. This is huge because it really makes the process of getting patients their drugs in the infusion suite much quicker. We don't have to track down a physician to sign those clinical trial orders. The AP can do that. And so this process is made much smoother. I think we'll see a lot of other cooperative groups and institutions follow suit with this. And I think this was a real demonstration of the AP's quality of care and the safety of AP prescribing and being able to have this privilege. Todd Pickard: Well, this has been a fascinating conversation today, and I would like everybody to have a final say. What's your take-home message today about what APPs can and can't do. And Tammy, we'll start with you.  Tammy Triglianos: Thank you. This was a great conversation today. Happy to be a part of it. Know that APPs with supportive, appropriate training, and, you know, I just have to shout out to Wendy and APSHO for the chemo prescribing course. I think this is huge for bridging a gap. Lots of education programs don't have oncology subspecialty, and this is such a comprehensive course that bridges a gap that I think will be huge. And I hope every oncology cancer center adopts, incorporating this to elevate the education and offer some subspecialty education to our oncology APPs. Kudos for all the team-based care and physician and APP teams out there that are really working hard to care for our cancer patients. Todd Pickard: Wendy, what are some of your final thoughts? Wendy Vogel: I have to agree with Tammy. I'm really excited about the APSHO Cancer Therapy Prescribing Course. I think that we can, together as a team, really make a difference in cancer care, playing to each other's strengths, and I think that would be my takeaway is: how can we better play to each other's strengths? Todd Pickard: Stephanie, what about some of your final thoughts? Dr. Stephanie Williams: I think working with APPs is critical to the success of any medical practice and to any physician who takes care of patients. Todd Pickard: Well, I appreciate all the insights. And just as a reminder, APPs and physicians, generally speaking, can decide whatever they want that is best for the practice, best for their patients, and delivers high-quality and safe care. Just be aware of your state regulations and find those institutional policies that are holding you back. Good news on the institutional policies - you can change them just like you can change your productivity metrics and models. So the good word is APPs and physicians can work in amazing teams, and we have all the power at our disposal to do so.  Well, I want to thank you to my co-host, Dr. Williams, along with Wendy and Tammy, for joining our discussion today and sharing all of your experience and highlights into the services that APPs can deliver. It's clear that APPs and physicians working together in teams are vital to a strong and efficient delivery of our team-based care.  Well, until our next episode, thanks, everybody, and take care. Thank you for listening to the ASCO Education Podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the Comprehensive Education Center at education.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Gonzalo Delacámara is Consultant on Natural Resources Economics for the United Nations and Water Policy Advisor for the OECD, the European Commission, and the World Bank. Gonzalo is also Director of the Center for Water & Climate Adaptation at IE University, aiming to reinvent education and train the people who will change the World tomorrow. Why does the World misbehave when it comes to Water? Why can't Water be truly circular when all water professionals agree it should be? Why do we still have to evangelize the World to the treasures of resource recovery? The list goes on and on. And from inside the Water Industry, it can get frustrating.  Yet, there's an unpleasant truth to accept: the Water Sector is an epiphenomenon on the broader scale of things. I know it's unfair, and it probably doesn't make sense, but it is simply and coldly true. This is how, as per the example Gonzalo shares today, people will pump up desalinated Water from the Sea to the Atacama desert - which represents the trifle of 250 bars of pumping - just because the commodity market can cover the cost. No one will dare to argue that it is sustainable to waste Water and energy just for some bits of copper. But as Gonzalo will demonstrate in a jiffy, the wrong incentives lead to the wrong results. So I'll let him develop the argumentation, as he'll do it much better than what I would bastardize here, but I will lead into that conversation with a straightforward question for all of us. In one month from the date I release this episode, the Water's who's who will converge to New York for the UN Water Conference. You've heard it all: once in a lifetime, didn't happen since Mar Del Plata in 1977, bla bla bla.  But are we sufficiently applying this advice we've got from Claudia Winkler and Alice Schmidt on this microphone by Season 3,  Episode 6? Are we zooming out before we zoom in? Will we aim for real solutions that break the water silo and really embrace the circularity nexus, or will we waste this opportunity with short-sighted debates?  If one assembly has the power to finally set the right incentives, that should be this one. So if you know a delegate that will attend the main or a side event, take this episode, and send it to him. Tell that water who's who that water people won't solve water alone. That we need circularity in the decision-making so that the entire system of systems ultimately gets circular.  Tell them, do it, and I'll meet you on the other side! Why do we have so many Good Reasons to make Wrong Water Decisions?

Matthew J. Lynch is an associate professor of Old Testament at Regent College in Vancouver, Canada. He is the author of First Isaiah and the Disappearance of the Gods, Portraying Violence in the Hebrew Bible, and Monotheism and Institutions in the Book of Chronicles. He is the co-founder of the OnScript podcast, a podcast focused on providing engaging conversations on Bible and theology. Episode Talking Points Matt Lynch, tuba player Matt's journey to Christ Understanding conversion Violence in the Old Testament The flood narrative Joshua and conquest Static rope/dynamic rope Core doctrines of Christianity The character creed of God in Exodus 34 Thinking through the mysteries of God Resources Flood and Fury Matthew Lynch on Twitter OnScript podcast --- Support this podcast: https://anchor.fm/the-monday-christian/support

Folks - Sorry about the delay in posting this episode. Producer Matt here, we had an internal tech issue, that is now resolved. We will be back to releaseing on our regular schedule moving forward. Thanks for everyone who reched out asking about Mark and Chuck. Today's Show Notes Chuck starts us out talking about the Grammy's. He wanted to watch it to see what us happening. It was an absolute out and out freaks show from beginning to end. Guys who are accepting awards in wind breakers and sneakers. There were men in silver clown suits. 50 years of hip hop was the anniversary last night...who wasn't in that line up - Chuck has never been so bored in his life - everything sounded the same. It would also appear that Satan has a place in the middle of the Grammy now, with a Sam Smith Ode to Satan. Chuck has a new word - Savant Idiots...really smart people who miss EVERYTHING. Lets take someone like Pete Buttigieg - he would appear to be a bright person, he is not a moron. But they are blind to the obvious. When the Bible talks about lifting the veil, perhaps these people have a veil over their minds...they live under the veil. We do not think that The Democratic Party, Foreign powers, the White House etc...to think that they all have quietly coordinated, and no one has spilled the beans is a ridiculous thought. However there is a power on earth who could put together a conspiracy...and these people are all willing participants. It has become less and less subtle, just more and more obvious. Mark's entire life, Mark has been aware that his government has lied to him since he was born. Chuck thinks this is a relatively new thing. People didn't or don't want to believe that the FBI, CIA, White House is corrupt. Mark thinks Kennedy (JFK) knew it, and he did not trust the Intel Community...look how that turned out for him. So we all have accepted that politicians lie, what is different now is that we are ok with Institutions lie...it is the new norm.

In this episode of the Millionaire Mindcast, we have Frederick Hubler, Jr. who shares insights and perspectives on what a model of a good investment portfolio looks like, private equity, institutional real estate, recession, inflation, consumer behaviors, interest rates, and how to win big in the 2023 recession! Frederick Hubler is an accomplished entrepreneur, Founder, CEO & Chief Wealth Strategist of Creative Capital Wealth Management Group, a comprehensive wealth management firm that helps improve every client's financial position, simplify their lives and help their clients find financial independence. He is also President of Retainer Based Academy LLC, a coaching and intellectual property firm for financial advisors. He has been featured in The Wall Street Journal, US News and World Report, TD Ameritrade, and countless podcasts, traditional, and digital mediums giving his outlook on the economy and stock market both locally and nationally. He is an innovative leader with a keen eye for unique solutions and vast knowledge in alternative wealth creation strategies. At a young age, Fred wanted to be an executive. He came from nothing, crappy and hungry. At 27 years-old, he worked in a Fortune 500 company where he felt like being in a toxic workplace environment. Thus, he learned not to trust anyone. It was too much that he decided he wanted to do his own thing. Then, he created Creative Capital Wealth Management Group. Fred always believes that if you want a typical return, you have to do something different. Also, you have to think outside of the box and find your uniqueness. It is knowing what you stand for, and building a system around that!   Some Questions I Ask: Talk a little bit about where your journey starts before Creative Capital Wealth Management Group? What does a model of a good investment portfolio look like? Over the course of your career, what are some of those lessons that the rich have mastered that people could adapt in their wealth-building journey or mindset along the way? What are one real estate investment that you are paying attention to that you've seen that have great returns from? What are some of the things that you subscribe to when it comes to building wealth for your children? What are your thoughts on where we're heading next year, how bad is it going to get, and what opportunities do you see in that season?   In This Episode, You Will Learn: How to get distinctive results. The smartest way to do the equity, and bond funds standpoint. Finding what you're good into and building system around that What is the largest and longest lived alternative investment. Why private equity is the crab of capitalism. Fred's definition of saving. The best traction for kids to build generational wealth. Why need to build-up cash.   Quotes: “The rich new thing, the rest of us didn't.”  “If you want an abnormal result, you have to take abnormal actions.” “Institutions like foundations, they don't die and they don't pay taxes.” “Go where you have an Ace and lead into that.” “Private equity is the crab of capitalism.” “Saving up to spend later isn't saving.” “The more one the many things you can do, it's the network of just where you're spending your time.” “When the narrative is trump by reality, reality will always win.” “History doesn't repeat but it rhymes.” “Cash is king.”   Connect with Frederick Hubler on:  Creative Capital Wealth Management Group LinkedIn   Sponsor Links: GoBundance  - Text: "MILLIONAIRE" to 844.447.1555 Indochino: Get 10% off of any purchase on $399 or more with the promo code: MINDCAST   Accredited Investor List - Text "DEALS" to 844.447.1555 Free Financial Audit: Text "XRAY" to 844.447.1555 Upcoming Events: Text "Events" to 844.447.1555 Millionaire Notes: Text "Notes" to 844.447.1555 Connect with Matty A. and Text me to 844.447.1555    Show Brought To You By: www.MillionaireMindcast.com Questions? Comments? Do you have a success story you would like to share on the show?  Send us an email to: Questions@MillionaireMindcast.com  

In this episode, I cover the second half of the second volume of lectures from Foucault's time at Le Collège de France titled, "Penal Theories and Institutions." If you want to support me, you can do that with these links: Patreon: https://www.patreon.com/theoryandphilosophy paypal.me/theoryphilosophy Twitter: @DavidGuignion IG: @theory_and_philosophy

By a Mocking of God and His Institutions, Threats to Our Churches, Country, and Jesus Followers Are Exacerbated MESSAGE SUMMARY: Our way of life is slipping quickly away from us, but our way of life is not just about elections and politics. This risk arises from direct threats to both our Christian faith-based institutions and our country's related founding principles. The news, 24/7, confirms that this risk is to our churches, to our country, and to our way of life. This threat is coming from a constant state of conflict among institutions, cultures, and individuals. The Bible provides examples of similar institutionalized conflicts throughout the ages. However, today's conflicts, in and among organized religion, are over the basic principles of Biblical teachings and Jesus' Gospel; and these conflicts make one wonder where the path for a way out of this descension and conflict will emerge.  From Clergy, Politicians, and the men and women in the street, God is mocked daily along with His institutions. Paul tells us, in Galatians 6:7, that: “Do not be deceived: God is not mocked, for whatever one sows, that will he also reap." Some ask, in a mocking fashion, “Where is Jesus; He is supposed to be the Peacemaker?”. Jesus answers this question in Matthew 10:34-35, 38-39: “Do not think that I have come to bring peace to the earth. I have not come to bring peace, but a sword. For I have come to set a man against his father, and a daughter against her mother, and a daughter-in-law against her mother-in-law . . . And whoever does not take his cross and follow me is not worthy of me. Whoever finds his life will lose it, and whoever loses his life for my sake will find it."    The risks from this conflict, arising from the mocking of God and the large numbers of institutions walking away from the Christian principles upon which America was founded, will only be addressed by a change in our hearts. The hearts of the people will not change until we have a true “spiritual awakening”. As Jesus tells us in John 14:1: “Let not your hearts be troubled. Believe in God; believe also in me.”. Additionally, Isaiah tells us in Isaiah 35:4: “Be strong; fear not! Behold, your God will come with vengeance, with the recompense of God. He will come and save you.”. A spiritual awakening is needed not only to save souls from eternal damnation but to save our way of life. This “Spiritual Awakening” begins by proclaiming Christ faithfully to the nations.   TODAY'S PRAYER: Lord, everything in me resists following you into the garden of Gethsemane to fall on my face to the ground before you. Grant me the courage to follow you all the way to the cross, whatever that might mean for my life. And then, by your grace, lead me to resurrection life and power. In Jesus' name, amen.   Scazzero, Peter. Emotionally Healthy Spirituality Day by Day (p. 100). Zondervan. Kindle Edition. TODAY'S AFFIRMATION: Today, because of I am filled with the Holy Spirit, I will not be controlled by my Despair. Rather, I will walk in the Spirit's fruit of Joy. “The fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness, gentleness and self-control.” (Galatians 5:22f). SCRIPTURE REFERENCE (ESV): John 20:19-25; John 16:33; John 14:27; John 1:14; 1 John 1:9; Luke 24:46; John 3:16; John 5:24; Romans 3:23; Romans 6:23; Romans 5:8; Romans 10:10; Romans 8:1; Romans 8:38-39; John 1:12; Psalms 52:1-9. A WORD FROM THE LORD WEBSITE: www.AWFTL.org. THIS SUNDAY'S AUDIO SERMON: You can listen to Archbishop Beach's Current Sunday Sermon: “The Interior Life – Maintenance of the Inner Man -- Part 3: The Will”, at our Website: https://awordfromthelord.org/listen/ DONATE TO AWFTL: https://mygiving.secure.force.com/GXDonateNow?id=a0Ui000000DglsqEAB