Podcasts about ipd

En esta edición de No Hay Derecho abordaremos, entre otros temas: - Caso Saweto: capturan a condenado Hugo Soria por el asesinato de cuatro líderes indígenas en 2014. - Consejo de Mujeres Awuajún vuelve a denunciar a abogado defensor público por acoso sexual en Condorcanqui. - Gremios de transporte de Lima y Callao convocan a paro el 25 de agosto si el Gobierno no atiende sus reclamos. - Universidades de arte rechazan recorte presupuestal y se movilizaron hacia el MEF. - Misión de Observación de la Unión Europea cuestiona papel de la prensa en la cobertura de la segunda vuelta electoral. - Renovación Popular busca silenciar a periodistas y penalizar su labor bajo la modalidad de "apología". - Ministro del Interior justifica continuidad de Óscar Arriola en la PNP: "El año pasado había 500 muertos más". - Alberto Beingolea rechaza propuesta del Minjus para trasladar el LUM y se muestra a favor de la derogación de la Ley del Artista”. - Funcionarios del Minedu dejan mal parada a Keiko Fujimori durante visita a zonas afectadas por lluvias en Lima. - Diputado Pier Figari defiende a Fernando Rospigliosi por críticas a jueces. - Actual jefe del IPD fue denunciado en el 2018 por contratar como asesoras a tres amigas de su esposa. - Exclusivo: Las leyes que observó José Balcazar.

Coronary revascularization in patients undergoing TAVI: an IPD meta-analysis of four randomized trials

Nach Stöcken und elektronischen Mobilitätshilfen im ersten Teil dreht sich nun alles um Braille. Los geht es mit dem Lernen und Schreiben der Punktschrift, von interaktiven Lernspielen bis zu einem Braille-Drucker, den auch Sehende ohne Vorkenntnisse bedienen können sollen. Danach nimmt sich Christian den größten Themenblock der ganzen Nachbetrachtung vor: Braillenotizgeräte und Braillezeilen. Erst geht es um die großen Geräte mit eigenem Betriebssystem, bei denen zwei Modelle in vielen Punkten erstaunlich nah beieinander liegen und deshalb direkt gegenübergestellt werden. Danach folgt ein Überblick über die schlankeren Braillezeilen für PC und Smartphone, sortiert nach Zeilenlänge, damit man bei der Fülle an Modellen den Überblick behält. Am Ende gibt es noch einen Tipp für alle, die sich gerade eine neue Braillezeile zulegen wollen. Erwähnte Produkte und Firmen: Annie und Tactera (Thinkerbell Labs), Handy-Exceller, Nemonic Dot (Dot Incorporation), Index Braille (Everest D V5), Interpoint, Enabling, ViewPlus, Elotype, Mountbatten Brailler (Harpo), Braillesense 7, Braillesense 6 Mini (Selvas/Hims), BrailleNote Evolve, Brailliant 80 (Humanware), MyKey Pro (BBTF), MyBraille-Serie, Activator, Activator Pro (Helptech), Braillex Flow +40 (Papenmeier), Brechmann Vision Access, Metec, Lucas Components (Vario-Serie, Vario Ultra), Focus 640 (Freedom Scientific ), Alva 640, ProTak, IPD, Orbit Research, Eurobraille, COM-M (Martin Mischler)

What is the sweet spot between digital project delivery and inclusive, diverse collaboration? Digital transformation is a significant player in the field of project delivery improvement and innovation. Sheryl Staub-French, a UBC Civil Engineering professor and 20-year infrastructure and building information modelling veteran, is the perfect spokesperson for its journey. Sheryl joins Evgenia for a conversation that centres change—both technological and cultural—for the betterment of the infrastructure industry. The sector is long (and infamously) plagued by the spectre of over-budget-and-over-time, and Sheryl's research seeks to uncover innovations that can shift this trend. It all starts, she stresses, at a systems level.  In their conversation, Evgenia and Sheryl explore Sheryl's leadership in equity, diversity, and inclusion, including her role as the first Associate Dean of ED&I in UBC's Faculty of Applied Science and the first female head of her department. Sheryl reflects on the persistent underrepresentation of women and Indigenous students in engineering, the importance of groundbreaking systems and culture change, and why inclusion of all kinds is not separate from project success. The discussion also burrows deep into the human and technical sides of infrastructure innovation. Pointing to specific successes in other countries, Sheryl argues that digital tools alone will not transform the industry unless owners, teams, and organizations are ready to change how they work together and implement that change at an organizational, not individual, level. Whether discussing BIM, IPD, AI, or engineering education, Sheryl returns to a core idea: better infrastructure delivery depends on better collaboration, better data, and better systems for bringing all voices and expertise into the work.Key takeawaysWhy Canada's lack of a national digital transformation strategy leaves infrastructure delivery behind its fellow G7 countries;How equity, diversity, and inclusion connect directly to better engineering education and on-the-ground outcomes;What's possible with a true, human-focused, collaborative IPD approach to infrastructure;Why collaboration requires aligned incentives, shared risk, shared reward, and trust—not just new tools;How AI could improve the efficiency and completeness of information commissioning and handover practices.Quote: “If people don't feel included, if it's not diverse, if all voices aren't being heard, it's not successful.” - Sheryl Staub-FrenchThe conversation doesn't stop here—connect and converse with our community via LinkedIn:Follow Navigating Major Programmes: https://www.linkedin.com/company/navigating-major-programmes/Read Riccardo's latest at www.riccardocosentino.comFollow Evgenia Jilina: https://www.linkedin.com/in/ejilina/  Follow Sheryl Staub-French: https://www.linkedin.com/in/sstaubfrench/ 

Just as pneumonia isn't “just a cold,” the pneumococcal vaccine does much more than just protect yourself or your child against pneumonia. Listen in and learn from experts Robert H. Hopkins, Jr., MD, and Brenda L. Tesini, MD, how to discuss the full benefits of pneumococcal vaccine.  Topics covered include: Burden of pneumococcal disease among pediatric and older adult populations in the United States Risk factors for severe pneumococcal disease Which pneumococcal vaccines to use for certain populations and why How pneumococcal vaccination protects from long-term sequelae and potential community benefits of vaccination Get access to all of our new podcasts by subscribing to the Decera Clinical Education Infectious Disease Podcast on Apple Podcasts, YouTube Music, or Spotify. Presenters: Robert H. Hopkins, Jr., MD Professor of Internal Medicine and Pediatrics Division of General Internal Medicine University of Arkansas for Medical Sciences, School of Medicine Little Rock, Arkansas Brenda L. Tesini, MD Associate Professor of Medicine, Pediatrics, and Community Health Division of Infectious Diseases University of Rochester Medical Center Rochester, New York Link to program page: https://bit.ly/3SuymiN Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Wer ein Braille-Notizgerät nutzt, eine 40er Zeile benötigt oder sich für smarte Brillen interessiert, findet in dieser Episode handfeste Informationen. Manfred Jaklin, Geschäftsführer von IPD aus der Region Hannover, gibt auf der SightCity 2026 einen ausführlichen Überblick über aktuelle Entwicklungen bei zwei Produktfamilien, die viele Nutzer in Deutschland betreffen. Zu Beginn geht es um Envision: Die Envision Glasses, die auf Google Glass basiert, ist am Ende ihrer Verfügbarkeit angelangt. Was das für Bestandsnutzer bedeutet und wie es bei Envision als Unternehmen weitergeht, beantwortet Jaklin so offen, wie es der aktuelle Informationsstand erlaubt. Den Hauptteil des Gesprächs nimmt das neue BrailleSense 7 von HIMS ein. Es erscheint in drei Varianten mit 20, 32 und 40 Zellen. Die Braillezeile unterstützt nun Touch-Gesten für Cursor-Routing und Navigation, ein seitlich angebrachtes Scrollrad ermöglicht schnelles Navigieren durch Texte und Menüs und eine aufsteckbare Qwerty-Tastatur gehört zum Lieferumfang. Ein optionaler Zusatzakku verlängert die Laufzeit auf 30 Stunden. Jaklin erklärt zudem, wann die einzelnen Varianten verfügbar sein werden und warum das 20er-Modell diesmal die gleiche Gehäusegröße wie das 32er bekommt. Abschließend kommt die Braille eMotion zur Sprache, die sich laut Jaklin als Verkaufsschlager etabliert hat, sowie die Frage, ob zukünftige Softwareerweiterungen in Planung sind.

Pneumococcal vaccine recommendations are constantly evolving to respond to shifting patterns of infections, which is a good thing. However, the nuances can be complicated to explain to patients. Listen in to learn how experts Richard Colgan, MD and Brenda L. Tesini, MD, discuss changing pneumococcal vaccine recommendations. Topics covered include:  Epidemiologic changes: S. pneumoniae over time Burden on patients and the health system Adjustments to pneumococcal vaccine recommendations Considerations for vaccine selection Get access to all of our new podcasts by subscribing to the Decera Clinical Education Infectious Disease Podcast on Apple Podcasts, YouTube Music, or Spotify. Presenters: Richard Colgan, MD Professor Emeritus Department of Family and Community Medicine University of Maryland School of Medicine Medical Alumni Association Carolyn Frenkil Selvin Passen History of Medicine Scholar in Residence Baltimore, Maryland Brenda L. Tesini, MD Associate Professor of Medicine, Pediatrics, and Community Health Division of Infectious Diseases University of Rochester Medical Center Rochester, New York Link to program page: https://bit.ly/3RNHkHr Links mentioned in this episode: PneumoRecs VaxAdvisor App for Vaccine Providers | Pneumococcal | CDC Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of The EBFC Show, Ines Verdun shares her experiences about takt planning, Integrated Project Delivery, Lean Construction, production engineering, and how contracts shape production flow in construction. Ines Verdun is a civil engineer with expertise in construction management and project delivery. She holds a Master of Science in Civil Engineering from UC Berkeley College of Engineering, where she was an active member of the IPD Team at Cal Construction, focusing on Integrated Project Delivery methodologies. She also earned her Bachelor of Science in Civil Engineering from Universidad Politécnica Taiwan Paraguay and works as a Production Engineer at The Boldt Company in San Francisco.   In this conversation, Ines shares her journey from Paraguay to UC Berkeley and The Boldt Company, where she experienced firsthand how Lean Construction works inside a real construction project. Felipe and Ines explore why takt planning is not just a scheduling method, why IPD helps teams collaborate differently, and how the role of a production engineer connects the schedule, field, office, trade partners, and project goals.   The big idea: contracts shape production flow.   If you are a construction leader, project manager, superintendent, scheduler, Lean coach, production engineer, trade partner, architect, owner, or anyone interested in better project delivery, this episode will help you see why Lean tools work best when the contract, leadership, and team behaviors support shared accountability.   In this episode, we cover: Why takt planning is a system, not just a schedule How IPD supports Lean Construction and trade partner collaboration Why traditional contracts can make Lean behavior harder The difference between takt planning and CPM scheduling How production engineers connect the field, office, and schedule Why trade partners need shared goals to improve project flow How risk and opportunity conversations support better project outcomes Why leadership and transparency matter in Lean project delivery How AI may accelerate construction management and project delivery   Subscribe for more conversations on Lean Construction, Construction Scrum, takt planning, Integrated Project Delivery, production systems, project delivery, leadership, and the future of construction.   #LeanConstruction #TaktPlanning #IntegratedProjectDelivery #ConstructionManagement #TheEBFCShow  

Серията Vox Nihili на Ratio Podcast и Предизвикай правото! изследва пресечните точки на науката и технологиите с етиката и правото, а също така и редица дискусионни теми от сферата на философията. Може би си спомняте, че имахме сходна серия събития на име Vox Nihili – сега ги пренасяме в аудио и видео формат. Любомир Бабуров и Стоян Ставру обсъждат: - Как се различават негативният от позитивният мир? - Каква е ролята на дипломацията? - Възможен ли е мир без институции (Имануел Кант)? - Може ли мирът да се мисли отвъд войната (Йохан Галтунг)? - Как един конфликт може да бъде (успешно) трансформиран, без да бъде (окончателно) решен (Джон Пол Ледерах)? - Има ли граници и същност понятието за позитивен мир (Кенет Боулдинг)? - Кои са ъглите на т.нар. „триъгълник на насилието“? - Каква е разликата между мира и покоят? - Възможен ли е „несправедлив мир“? - Какво представляват студеният мир, въоръженият мир, мирът въз основа на страх…? - Как концепцията за позитивен мир се съотнася към доктрината за ядрено сдържане? - Може ли да се измерва и операционализира позитивния мир (Нилс Гледич)? - Какво му е лошото на „либералния мир“ (Дъстин Шарп)? - Чий мир е позитивният мир и как мирът е свързан със свободата? - Какво представлява „релационният мир“? - Кои са „пазителите“ и кои са „враговете“ на мира? - Ако естественото състояние „война на всеки срещу всеки“, то какво е „мирът на всеки с всеки“? Гледайте епизода тук: https://youtu.be/nb2Tyoc2RfU Най-честата дефиниция на мира включва през „липсата на война“. Това обаче може да се окаже само неговата най-повърхностна форма, обозначавана в изследванията на мира (peace studies) като „негативен“ мир. Истинско предизвикателство се оказва същността на концепцията за т.нар. „позитивен“ мир – мир, който не просто изключва насилието, а създава условия за съвместен живот заедно с конфликтите. Историята на Студената война показва, че е възможен „мир чрез страх“, при който взаимното възпиране предотвратява войната, но не създава доверие. Това поставя въпроса дали такъв мир изобщо е мир или по-скоро замразена форма на война. Съвременните теории предлагат да изоставим идеята за окончателно „решаване“ на конфликтите и вместо това да мислим за различните начини на тяхното трансформиране. Кратката етимологична справка за думата „мир“ в различните езици допълнително разкрива, че мирът мислен като активен процес (усилие) по поддържането на общност, сключването и изпълнението на договор, осигуряването на защита, а не като състояние пасивен покой (състояние). В крайна сметка мирът се оказва не крайна точка в човешката история, а постоянна практика – „миростроителство“. Какво бихме могли да кажем за позитивния мир и важна ли е в крайна сметка тази концепция за нашия ежедневен живот. Допълнителни материали: https://press.bas.bg/bg/books-103/show-104(858) https://www2.kobe-u.ac.jp/~alexroni/IPD 2015 readings/IPD 2015_7/Galtung_Violence, Peace, and Peace Research.pdf https://www.amazon.com/GALTUNG-DEVELOPMENT-CIVILIZATION-Civilization-International/dp/0803975112 https://gruposhumanidades14.wordpress.com/wp-content/uploads/2014/10/john-paul-lederach-the-moral-imagination_the-art-and-soul-of-building-peace.pdf https://ideas.repec.org/a/sae/joupea/v14y1977i1p75-86.html?utm_source=chatgpt.com https://academic.oup.com/jpr/article/51/2/145/8365769?login=false https://academic.oup.com/isr/article-abstract/22/1/122/5203542?redirectedFrom=fulltext&login=false

Overnight in the US, Wall St rebounded from yesterday's sell off, spurred by software stocks as investors fears of AI disruption were eased. The tech heavy Nasdaq lead the way jumping 1%, while the S&P500 and Dow Jones both advanced 0.8%.What to watch today:Back home the ASX is expected to follow suit, with the SPI futures pointing to a 0.75% jump at the open of trade.In reporting season, gaming machine supplier Light and Wonder (ASX:LNW) has reported a 4% rise in revenue to US$3.3 billion, an adjusted net profit before amortisation increase of 18% to US$567 million, which puts them firmly in line with guidance.Other major companies are due to release their results this morning, including Fortescue Metals (ASX:FMG), Woolworths (ASX:WOW) and WiseTech Global (ASX:WTC).So far this reporting season, 206 companies have reported their results, with 38% beating expectations, 32% in line, and 30% missing expectations.Following on from their results, Bell Potter have upgraded end-to-end mining technology solutions provided Imdex (ASX:IMD) from a hold to a buy, and increased their 12-month price target from $3.60 to $4.60 per share. This comes after they announced an underlying EBITDA increase of 22% YoY, which beat forecast by 9%.Similarly, they have maintained their Buy rating on electrical equipment distributor IPD group (ASX:IPG), with a 12-month price target of $5.30, after thei announced an 8% underlying EBITDA increase YoY, which represented a 2% beat on forecast.Additionally today, keep an eye on the January CPI data which is due at 11:30am Sydney today – NAB analysts have predicted that both headline and trimmed-mean inflation will remain unchanged for the month, so any unexpected changes could impact the markets.Finally ending with commodities news,Crude oil has once again remained flat for the 3rd consecutive day, trading at slightly over US$66 per barrel.For precious metals, both gold and silver have pulled back slightly from yesterday's highs, with the former down 1.3% to US$5161 per ounce, and the latter down 1% to US$87.30 per ounce.

En esta edición de No Hay Derecho abordaremos, entre otros temas: - Fernando Rospigliosi presiona al Poder Judicial para aplicar ley que abre la puerta a la prescripción de delitos de lesa humanidad. - El presidente del Consejo de Ministros minimiza paro de transportistas del 15 de enero. - Encapuchado y sin registros oficiales: José Jerí se reunió con empresario chino vinculado a Nicanor Boluarte. - José Jerí está “plenamente de acuerdo” con la operación de EE. UU. en Venezuela: “Era una medida necesaria". - Informe de IDL-Reporteros: La decapitación de los equipos especiales - Elecciones 2026: solo 12% de peruanos ya decidió su voto presidencial, según Datum. - Exclusivo: Despilfarro de dinero en el IPD

In this episode of Bring the Pain, I'm back with another Hard Hits Review after a wild weekend in the NFL, UFC, and NBA. I talked about my hits and misses from the weekend while calling some players out that need to be called out. After letting the Painbringer out, I end things like usual by revealing my IPD waiver wire pick up of the week and my Macho Pick of the Week for this week's DFS slates. Let's smash it this week as we get ready to slay the slates once again. Have a great day, everyone, and may the points be with you.

In this episode of Bring the Pain, I'm back with another Hard Hits Review after a wild weekend in the NFL, UFC, and NBA. I talked about my hits and misses from the weekend while calling some players out that need to be called out. After letting the Painbringer out, I end things like usual by revealing my IPD waiver wire pick up of the week and my Macho Pick of the Week for this week's DFS slates. Let's smash it this week as we get ready to slay the slates once again. Have a great day, everyone, and may the points be with you. Thank you for the support and contributions all of you make for my podcasts and articles each week. Y'all the real #Painbringers! Follow me at.... *Facebookhttps://www.facebook.com/Bring... *Twitterhttps://twitter.com/HeatOverid... *Spreaker Podcastshttps://spreaker.page.link/VS5... *Dr Roto Sports Websitehttps://drroto.com/author/robe... *You Tubehttps://youtube.com/@Heat00veride05?si=cVb49FjQD-Y6fKjT *Apple Podcastshttps://podcasts.apple.com/us/... *Spotify Podcastshttps://open.spotify.com/show/... *Podchaser Podcastshttps://www.podchaser.com/podc... *Iheart Podcastshttps://www.iheart.com/podcast... #ufc​ #nfl​ #nba​ #drroto​ #bringthepain​ #sportsbetting​ #ultraontrarianshow​ #hardhitsreview​ #fightclubofpain​ #ufcsheriffs​ #betting​ #dfs​ #hottakes​ #badplay​ #ufc321​ #aspinallvsgane​ #eyepoke​ #fighttheory​ #gametheory​Become a supporter of this podcast: https://www.spreaker.com/podcast/bring-the-pain--3659369/support.

**Red Media is hiring an Executive Director!**   Happy Indigenous Peoples' Day 2025 from Red Media! Track List 1. Introduction / Justine  2. Indigenous Peoples' Day vs. Empire Pt. 1  3. City of Albuquerque proclamation of Indigenous Peoples' Day  4. IPD 2021 - Pueblo Elders Panel 5. IPD 2022 - Ké Infoshop 6. Indigenous Peoples' Day vs. Empire Pt. 2  7. IPD 2023 - Wael Omar/Palestinian Youth Movement   Empower our work: GoFundMe: https://www.gofundme.com/f/empower-red-medias-indigenous-content  Subscribe to The Red Nation Newsletter: https://www.therednation.org/ Patreon www.patreon.com/redmediapr    

This episode gets real about why good delivery models go bad. Jason breaks down the traps that derail IPD, Design-Build, and CM at Risk, and shows how systems thinking, flow, and true collaboration keep projects on track. Key points: The “competitive design proposal” trap burns millions and cannibalizes unpaid design. Phased design without a full kit leads to rework: missing sleeves, embeds, blue bangers, and chaos. If it violates Goldratt's Rules of Flow, it will fail no matter the contract wrapper. Deming's lesson: we fail despite best efforts when we don't think in systems. Stop sub-optimizing and start collaborating across teams, trades, and tech. Update your playbooks continuously instead of treating methods as frozen versions. If you want delivery models that actually deliver, build the system first, protect flow, and make collaboration non-negotiable. If you like the Elevate Construction podcast, please subscribe for free and you'll never miss an episode.  And if you really like the Elevate Construction podcast, I'd appreciate you telling a friend (Maybe even two

This week on Better Buildings for Humans, Joe Menchefski sits down with Renée Jacobs, healthcare sustainability powerhouse and leader at DisTech and Atrius, for a revealing conversation on how indoor air quality (IAQ) and building automation systems are shaping the future of human-centered design. From managing hospitals to spearheading cutting-edge AI integration, Renée brings a deep well of knowledge—and a few sharp truths. They explore why proper humidification might be the most overlooked health intervention, how AI and heat mapping could one day save lives in emergency evacuations, and what really changed in building science post-COVID. Plus, Renée challenges architects and engineers to think beyond design—to future-ready buildings that respond to people, not just spreadsheets. This episode is a wake-up call for anyone still thinking IAQ is just about filters.More About Renée JacobsRenée Jacobs is a Certified Healthcare Facility Manager, Certified Healthcare Constructor and Fellow ASHE with more than 30 years and over $1 billion of experience in construction project management, healthcare facilities management and technical sales and management. Ms. Jacobs is the Business Development Manager – Healthcare for Distech Controls.Formerly as Vice President of Facilities and Construction at Saint Luke's Health System, Ms. Jacobs had oversight of all areas of design, construction, renovation, master planning, and plant operations and maintenance for 11 Kansas City area hospitals. Jacobs led the New Saint Luke's $330 million capital construction project, successfully completing a portion of the project as the first integrated project delivery (IPD) project for the health system.Ms. Jacobs is an active member of ASHE, serving as faculty, professional reputation committee chair and several task forces. She is active in the local ASHE chapter, the Kansas City Area Healthcare Engineers (KCAHE) and has served on the board as president, past-president and secretary. Additionally, Ms. Jacobs is a founding board member of LEAN KC, a chapter of the Lean Construction Institute, is a member of the University of Nebraska Construction Industry Advisory Committee and the Overland Park Rotary Club.CONTACT:https://www.linkedin.com/in/renee-r-jacobs/ Where To Find Us:https://bbfhpod.advancedglazings.com/www.advancedglazings.comhttps://www.linkedin.com/company/better-buildings-for-humans-podcastwww.linkedin.com/in/advanced-glazings-ltd-848b4625https://twitter.com/bbfhpodhttps://twitter.com/Solera_Daylighthttps://www.instagram.com/bbfhpod/https://www.instagram.com/advancedglazingsltdhttps://www.facebook.com/AdvancedGlazingsltd

Marty talks about a new precision fit patent filed for Apple Vision ProProNotesA Future Version of Apple's Vision Pro may provide users with a Precision Fit through Dynamic Adjustment Mechanismshttps://www.patentlyapple.com/2025/08/a-future-version-of-apples-vision-pro-may-provide-users-with-a-precision-fit-through-dynamic-adjustment-mechanisms.html The gist: Apple just had a patent spotlighted that's all about a “precision fit” Vision Pro—hardware that dynamically adjusts (think buttons/levers/dials, possibly motor-assist) to match each person's head and face. What Apple's aiming to fix: Current headsets (including today's Vision Pro) rely on manual straps and swapping cushions—fine, but fiddly—and comfort can drift during longer sessions. Apple's patent pushes toward auto-tuning hardware that gets you into the sweet spot faster and keeps you there. How it might work :- Dynamic supports: A headset frame that actively redistributes pressure so you don't get forehead/cheek hot spots. - Smart light seal concepts: Related Apple filings describe air bladders/valves that balance pressure across face zones—tight where you need it, forgiving where you don't. - Guided fit is the point: All of this is about landing your eyes in the optical “sweet spot” quickly and repeatably—clearer picture, less strain. (IPD alignment = sharper visuals is a known VR truth.) Why users should care:Comfort goes up, face marks go down. Longer, easier sessions. Faster hand-off: Family or teammates can throw it on and get tuned quickly—less strap fussing. More consistent clarity: Staying centered improves text and UI readability and reduces fatigue. Why this could advantage Apple vs. competitors:- Closed-loop fit (hardware + software): If Apple marries sensors, adjustable seals, and on-device guidance, you get a set-and-forget fit most rivals can't match with manual strap/IPD dials. - Perceived quality without new screens: Better, repeatable alignment makes the whole system feel sharper and more premium—no panel change required. - On-boarding win: Less tinkering = more people actually enjoying the demo, which matters for adoption. Where we are today: Vision Pro already uses swappable Light Seals/cushions and bands to improve fit; the patent path suggests Apple wants to automate more of that. Caveat: Patents ≠ products. Timelines aren't promised, but Apple's recent filings draw a clear line: comfort and precision fit are priority areas for the next wave of Vision hardware. Bottom line: If Apple ships even part of this self-tuning fit stack, Vision Pro could feel lighter, clearer, and friendlier to share—a practical edge that's hard for manual-only headsets to match.Follow the live stream at YouTube.com/@VisionProfiles on Monday nights at 9 PM EST or catch the video later on Youtube or audio on any pod catcher serviceMacStockMacstockconferenceandexpo.com Email: ThePodTalkNetwork@gmail.comWebsite: ThePodTalk.Net

Join us on this episode of the Global Fresh Series as we follow the journey of the Import Promotion Desk (IPD) — a dynamic organization connecting small and medium-sized suppliers from emerging markets to the European Union. With the support of Germany's Federal Ministry for Economic Cooperation and Development, IPD helps pave the way for long-term trade relationships that benefit both sides of the global value chain.Our guest, sourcing specialist Dorra Zairi, shares how IPD is constantly on the go — from farm visits to trade show floors — identifying opportunities, vetting partners, and building trust across borders. Curious where Dorra is headed next? So are we. Tune in to find out!First Class Sponsorship: Peak of the Market: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://peakofthemarket.com/⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

In this international edition of the EMS One-Stop podcast, host Rob Lawrence welcomes Lewis Andrews, the chief operating officer of the United Kingdom's College of Paramedics, for an insightful discussion on two major topics shaping global paramedicine. First up is International Paramedic Day, taking place on July 8, 2025. Now in its third year, the day honors the contribution of paramedics across the world and draws its inspiration from the birthday of Dominique-Jean Larrey, the father of battlefield ambulance care. Lewis explains how the day has grown from 50 initial partners to over 150 global organizations, with this year's theme being “Unity and community.” The day aims to raise awareness of the profession, share innovations and bring together the global paramedic community. MORE | How community paramedicine is thriving in the UK: Dr. Linda Dykes and Rom Duckworth discuss trans-Atlantic lessons in emergency management In the second half of the show, Lewis delves into the structure and significance of the College of Paramedics, which represents nearly half of the UK's registered paramedics. He describes how the UK paramedic profession is regulated and protected by law, with a rigorous educational pathway that now includes the potential for prescribing paramedics and direct-to-primary-care tracks. Rob and Lewis explore how paramedics in the UK are increasingly working beyond emergency ambulances — in GP surgeries, urgent care centers and academic roles. Their conversation offers a rich comparison point for U.S. EMS leaders seeking to elevate paramedicine through autonomy, education and broader clinical roles. Memorable quotes “This is not a commercial platform — this is about us celebrating us.” — Lewis Andrews, on the ethos of International Paramedic Day “Let's not reinvent the wheel, but let's look at what the wheel is for the environment that it's required to roll in.” — Lewis Andrews, on global EMS collaboration “The title ‘paramedic' is protected by law in the UK — you can't simply do a first aid course and call yourself one.” — Rob Lawrence “Autonomy — in a word — that's what makes a prescribing paramedic.” — Lewis Andrews, on expanding paramedic roles “We're also promoting the profession to those who don't yet know they want to be in the profession.” — Lewis Andrews, on recruitment and professional identity “We have a career framework … that actually shows that you can develop from that day one newly qualified right through to a consultant paramedic, chief paramedic, director, professor.” — Lewis Andrews Episode timeline 00:55 – Introduction to International Paramedic Day (IPD) and its origins 02:17 – Why July 8 was chosen: Dominique-Jean Larrey's birthday 03:02 – Growth of IPD from 50 to over 150 partners 05:06 – 2025 theme: “Unity and community” and sub-objectives 06:45 – How to participate: share stories, use hashtags (#UnityAndCommunity and #IPD2025), connect globally 08:58 – The global nature of IPD and U.S. partners' involvement 11:25 – Promoting awareness and the importance of celebrating paramedics 12:50 – Part 2 — The role of the College of Paramedics 14:09 – Overview of College functions: CPD, representation, research, advocacy 18:15 – Registration with HCPC, protected title and the regulator's role 21:12 – Paramedic education in the UK: degree pathways, demand and cost 23:46 – Discussion on streaming directly into primary care roles 27:09 – Career framework: from graduate paramedic to chief paramedic/professor 30:16 – Prescribing paramedics: autonomy and improved patient experience 33:08 – Recap and call to action: visit www.internationalparamedicsday.com 34:17 – Like, subscribe and engage ADDITIONAL RESOURCES International Paramedics Day Resources UK College of Paramedics The standards of proficiency for paramedics RATE & REVIEW Enjoying the show? Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

(00:00) Golf Discussion With Joe Bosco This chapter takes a fascinating look at the mental and emotional aspects of golf with special guest Joe Bosco, a respected expert in human performance. We discuss how the mind can both enhance and inhibit physical performance on the golf course, emphasizing the importance of mental control and emotional management. Joe shares insights into how golfers can improve by integrating mental strategies with physical skills, transforming them into more complete players. We explore scenarios that test a golfer's mental resilience, like facing a challenging par three over water, and highlight the common tendency for golfers to get stuck in their heads, focusing too much on mechanics rather than trusting their skills. Through this engaging conversation, we aim to help golfers overcome mental obstacles and enhance their performance by aligning their mind and body. (06:57) Navigating Parental Pressure in Junior Golf This chapter addresses the pressing issue of parental pressure in youth sports, particularly in junior golf. We explore the detrimental effects of parents who hover over their children, pushing them to perform for reasons tied to parental pride rather than the child's love for the game. Discussing personal experiences and observations, we highlight the shift from a time when young athletes played more independently to the current landscape where children often face burnout from external pressures. The conversation touches on the mental and emotional hurdles young athletes encounter, exacerbated by parental involvement and social media influences, and stresses the importance of allowing children to develop their skills and passion independently. (15:43) Mental Game in Junior Golf This chapter explores the misconceptions around perfectionism in golf, particularly for young players and their parents. I share an anecdote about an eighth-grade golfer and his parents, who have a skewed perspective due to watching highlight reels on TV, thinking professional golfers like Tiger Woods never make mistakes. By showing them PGA Tour bloopers, I challenge this perception, highlighting the reality that even top golfers miss shots. We discuss how parents, especially those unfamiliar with golf, may place unrealistic expectations on their children, drawing parallels with other sports like baseball, where failure is more accepted. I also touch on strategies for improving golf performance, referencing Joe's book "Real Golf." A key method is the self-scramble, where players hit multiple shots and choose the best one, fostering self-coaching and adaptability, essential skills in golf due to its nature of constant adjustments. (27:39) Visualization Training for Golf Performance This chapter explores the transformative power of an app designed to enhance golfers' performance by focusing on mental conditioning and visualization techniques. We discuss the importance of helping both parents and young golfers navigate the pressures of the sport, while also highlighting the app's benefits for adult players like John. The conversation touches on the app's integration of hypnotherapy elements, which aim to retrain players' responses to pressure situations, ultimately leading to improved performance. Jeff's insights on reducing pressure and fostering positivity through strategies like not keeping score but counting good shots are emphasized. A success story is shared about a young golfer who, through the app's training modules and recordings, significantly improved his ability to visualize and recall details from his games, impressing even his mother with his progress. (32:25) Mastering Mental Performance in Golf This chapter focuses on the power of visualization in enhancing golf performance and overall human potential. We explore the concept of "pre-living," which goes beyond traditional visualization by incorporating all senses and emotions to vividly imagine and rehearse future actions. Jeff Smith, a top 100 golf instructor, and Joe Bosco, a mental performance expert, discuss how this technique can help golfers of all levels by fostering a positive mindset and focusing on constructive thoughts. We also introduce Joe Bosco's newly launched app, Real Mental Golf, available in the Apple Store, which offers tools and content to support mental training for golf and life. Through engaging community features and resources, users can strengthen their focus and concentration, overcoming negative spirals to enhance performance on and off the golf course. (37:48) Mindset Mastery in Golf Coaching This chapter focuses on the significance of mental coaching in golf and how leveraging positive thoughts can enhance performance. We explore the idea of "give credit and steal shamelessly," emphasizing the value of being a transmitter of good ideas to foster personal growth and enjoyment in the game. Highlighting contributions from renowned mental coaches like Dr. Bob Rotella and Brett McCabe, the discussion underscores the importance of mindset in both individual and competitive play. By focusing on positive outcomes, such as counting good shots, golfers can shift their mindset to improve performance and enjoy the game more. A personal anecdote about helping a young player overcome the pressures of competitive golf illustrates how the right mental approach can transform one's experience. (43:05) Fascination in Golf Mindset Training This chapter focuses on cultivating a positive mindset on the golf course by encouraging players to embrace every shot, whether good or bad, with the phrase "Isn't that fascinating?" We explore how holding one's finish and maintaining balance while acknowledging the result can help take the pressure off, turning the game into an enjoyable learning experience. I share insights from working with corporate groups, where introducing this perspective leads to laughter and relaxation, even among CEOs. By reminding ourselves that golf is a game meant for fun and learning, we can enhance our performance without being bogged down by unrealistic expectations. This approach allows us to learn more effectively by focusing on enjoyment rather than self-criticism. Access the App for iPone of iPd here: (00:00) Golf Discussion With Joe Bosco This chapter takes a fascinating look at the mental and emotional aspects of golf with special guest Joe Bosco, a respected expert in human performance. We discuss how the mind can both enhance and inhibit physical performance on the golf course, emphasizing the importance of mental control and emotional management. Joe shares insights into how golfers can improve by integrating mental strategies with physical skills, transforming them into more complete players. We explore scenarios that test a golfer's mental resilience, like facing a challenging par three over water, and highlight the common tendency for golfers to get stuck in their heads, focusing too much on mechanics rather than trusting their skills. Through this engaging conversation, we aim to help golfers overcome mental obstacles and enhance their performance by aligning their mind and body. (06:57) Navigating Parental Pressure in Junior Golf This chapter addresses the pressing issue of parental pressure in youth sports, particularly in junior golf. We explore the detrimental effects of parents who hover over their children, pushing them to perform for reasons tied to parental pride rather than the child's love for the game. Discussing personal experiences and observations, we highlight the shift from a time when young athletes played more independently to the current landscape where children often face burnout from external pressures. The conversation touches on the mental and emotional hurdles young athletes encounter, exacerbated by parental involvement and social media influences, and stresses the importance of allowing children to develop their skills and passion independently. (15:43) Mental Game in Junior Golf This chapter explores the misconceptions around perfectionism in golf, particularly for young players and their parents. I share an anecdote about an eighth-grade golfer and his parents, who have a skewed perspective due to watching highlight reels on TV, thinking professional golfers like Tiger Woods never make mistakes. By showing them PGA Tour bloopers, I challenge this perception, highlighting the reality that even top golfers miss shots. We discuss how parents, especially those unfamiliar with golf, may place unrealistic expectations on their children, drawing parallels with other sports like baseball, where failure is more accepted. I also touch on strategies for improving golf performance, referencing Joe's book "Real Golf." A key method is the self-scramble, where players hit multiple shots and choose the best one, fostering self-coaching and adaptability, essential skills in golf due to its nature of constant adjustments. (27:39) Visualization Training for Golf Performance This chapter explores the transformative power of an app designed to enhance golfers' performance by focusing on mental conditioning and visualization techniques. We discuss the importance of helping both parents and young golfers navigate the pressures of the sport, while also highlighting the app's benefits for adult players like John. The conversation touches on the app's integration of hypnotherapy elements, which aim to retrain players' responses to pressure situations, ultimately leading to improved performance. Jeff's insights on reducing pressure and fostering positivity through strategies like not keeping score but counting good shots are emphasized. A success story is shared about a young golfer who, through the app's training modules and recordings, significantly improved his ability to visualize and recall details from his games, impressing even his mother with his progress. (32:25) Mastering Mental Performance in Golf This chapter focuses on the power of visualization in enhancing golf performance and overall human potential. We explore the concept of "pre-living," which goes beyond traditional visualization by incorporating all senses and emotions to vividly imagine and rehearse future actions. Jeff Smith, a top 100 golf instructor, and Joe Bosco, a mental performance expert, discuss how this technique can help golfers of all levels by fostering a positive mindset and focusing on constructive thoughts. We also introduce Joe Bosco's newly launched app, Real Mental Golf, available in the Apple Store, which offers tools and content to support mental training for golf and life. Through engaging community features and resources, users can strengthen their focus and concentration, overcoming negative spirals to enhance performance on and off the golf course. (37:48) Mindset Mastery in Golf Coaching This chapter focuses on the significance of mental coaching in golf and how leveraging positive thoughts can enhance performance. We explore the idea of "give credit and steal shamelessly," emphasizing the value of being a transmitter of good ideas to foster personal growth and enjoyment in the game. Highlighting contributions from renowned mental coaches like Dr. Bob Rotella and Brett McCabe, the discussion underscores the importance of mindset in both individual and competitive play. By focusing on positive outcomes, such as counting good shots, golfers can shift their mindset to improve performance and enjoy the game more. A personal anecdote about helping a young player overcome the pressures of competitive golf illustrates how the right mental approach can transform one's experience. (43:05) Fascination in Golf Mindset Training This chapter focuses on cultivating a positive mindset on the golf course by encouraging players to embrace every shot, whether good or bad, with the phrase "Isn't that fascinating?" We explore how holding one's finish and maintaining balance while acknowledging the result can help take the pressure off, turning the game into an enjoyable learning experience. I share insights from working with corporate groups, where introducing this perspective leads to laughter and relaxation, even among CEOs. By reminding ourselves that golf is a game meant for fun and learning, we can enhance our performance without being bogged down by unrealistic expectations. This approach allows us to learn more effectively by focusing on enjoyment rather than self-criticism.

What if planning with your builder from day one could save you hundreds of thousands?   In this episode, I sit down with Nick Roth, founder of Habikon, to break down what truly makes a real estate project succeed. From building high-end custom homes to multifamily developments, Nick shares how he turned his love for structure into a company that thrives on trust, collaboration, and detailed planning.   We talk about why most projects go over budget, how to fix it with integrated project delivery (IPD), and the surprising tech stack powering his construction process. Nick explains how aligning expectations upfront, building in phases, and using cost simulation tools are helping clients build smarter—not just bigger.   Tune in to hear why planning is the most underrated skill in real estate—and how choosing the right builder could be your biggest investment decision.   —   Tired of spreadsheets and admin headaches in your rental business?   If you're a real estate investor looking to simplify operations and grow your portfolio, Kompas is your new best friend. This all-in-one property management and accounting software helps you automate the tedious stuff—like receivables, renewals, and leasing—so you can focus on creating value.   Boost your cash flow, improve your NOI, cut down back-office work, and scale with confidence.  

Darlene Cadman joins Justin Neagle to discuss Integrated Project Delivery (IPD) in the AEC industry. They explore IPD contracts, focusing on collaboration, risk, and reward sharing, and emphasize target value design and team selection in lean construction. Darlene shares insights on lean practices, including respect for people and understanding flow, as well as pull planning, visual planning, and collaboration. The episode highlights the importance of leadership, accountability, and structured planning in both work and personal life. It concludes with Darlene's contact information and productivity hacks.

Take 10 with Tim – May 2, 2025 – 7:00/6:00 amMicrosoft Teams:PodcastFriday, May 2, 20257:00 AM - 8:30 AMhttps://teams.live.com/meet/9344301938391?p=FbWCGwzXFMz4LKSw4a1.Closers have once again been the bane of many fantasy managers' existence. I know I'm struggling. I have excellent teams in a couple of leagues, but my closers suck or are hurt. Last Sunday, I spent a fortune on Will Vest in Detroit as it looked like he had the job. Now, maybe he doesn't.a.What's your advice for me and others who are struggling?b.Should managers go for the hot potential closer like Vest or instead spend less on setup guys?2.Potential young breakout pitchers. Who are you buying? We will talk about each and then I'll have you order them in how you like them for the rest of the season and then their careers?a.Brandon Pfaadt (AZ, age=26, rank=18) – 6 GS, 5 wins, 2.78 ERA, 1.12 WHIP, 29Ks/4BB in 35.2 IPb.Jesus Luzardo (PHI, 27, 15) – 6 GS, 3 wins, 1.73 ERA, 1.07 WHIP, 41K/10BB in 36.1 IPc.McKenzie Gore (Was, 26, 26) – 7 GS, 2 wins, 3.51 ERA, 1.10 WHIP, 59K/9BB in 41 IPd.Max Meyer (Mia, 26, 37) – 6 GS, 2 wins, 3.18 ERA, 1.20 WHIP, 47K/11BB in 34 IPe.Casey Mize (Det, 28, 42) – 5 GS, 4 wins, 2.12 ERA, 1.05 WHIP, 23K/7BB in 29.2 IP3.Potential young breakout pitchers. Who are you buying? We will talk about each and then I'll have you order them in how you like them for the rest of the season and then their careers?a.Pete Crow Armstrong (CHC, 23, 10) - 6 HR, 12 SB, 23 runs, 21 RBI, .315 BAb.Tyler Soderstrom (ATH, 23, 50) – 9 HR, 1 SB, 20 runs, 24 RBI, .349 BAc.Spencer Torkelson (Det, 25, 65) – 8 HR, 1 SB, 20 runs, 24 RBI, .359 BAd.Wilyer Abreu (Bos, 25, 78) – 6 HR, 4 SB, 18 runs, 21 RBI, .295 BAe.Ben Rice (NYY, 26, 113) – 8 HR, 2 SB, 22 runs, 13 RBI, .266 BA4.In doing the research for the potential breakouts, two players caught my eye. What do you think about these two:a.JP Sears (ATH, 29, 33) – 6 GS, 4 wins, 2.94 ERA, 1.07 WHIP, 30K/6BB in 33.2 IPb.Griffin Canning (NYM, 28, 40) – 6 GS, 4 wins, 2.61 ERA, 1.38 WHIP, 31K/14BB in 31 IP5.Lance McCullers Jr (Remember him?) will make his 2025 debut on Sunday against the White Sox. I'm assuming you have to start him, but is there anything there with this kid or is it impossible to tell?a.Ranger Suarez also makes his debut on Sunday against the Diamondbacks. Are you starting him?b.ROS – McCullers or Suarez?6.Over/Under gamea.Aaron Judge: AL MVP – more yes or nob.Oneil Cruz: 1st round pick in 2026 – more yes or noc.Corbin Carroll: 25-25 seasond.Kyle Manzardo: 30 HRse.MacKenzie Gore: 200 strikeouts – 11 were over 200 in 20247.What hitter are you targeting for this week's FAAB?8.What pitcher are you targeting for this week's FAAB?

“This isn't like a conference you go to and just listen to people give presentations, this is interactive. You're actually solving real world problems and working together to come up with those solutions. {You} have everyone at the table, really why you want to join is so you can be at the table and direct the future of our industry.” In this conversation, Devon Tilly and co-host Nathan Wood chat with Todd Sutton from Zachary Corporation! This podcast is a part of a series of episodes that will be coming out from now until Spring 2025 covering the AEC Summit in Austin, Texas April 23rd – 25th 2025. We encourage our listeners and partners to share and engage with us during this conference coverage! With over 35 years of construction industry service with Zachry Corporation, Todd has supported various business units and industry markets in finding user-inspired, process-based solutions through the implementation of technologies or construction methods to assist in project execution. He is an enthusiastic advocate for workforce initiatives, participating in Zachry's Career Exploration Program internship for high school students. At Zachry Corporation, he works on R&D to improve processes, as well as on the technologies that enable these improvements. He is currently involved in several industry data exchange standards, primarily focused on openBIM IFC efforts and FHWA, AASHTO, and State DOT-led digital delivery efforts. Co-host Nathan Wood understands how rewarding the design and construction process can be when technology and culture embrace a new era of innovation. Nathan first earned his reputation as an industry thought leader in 2011, sharing his award-winning implementation of virtual design and construction (VDC) while working on integrated project delivery (IPD) healthcare projects. Nathan strives to share the best practices and lessons learned he's gathered from over 100 project teams spanning the US, Europe, and the Middle East. These experiences have taught him that when it comes to adopting technology in construction, it's not one size fits all. For that reason, Nathan founded SpectrumAEC with a clear goal — solving the human barriers to new process and technology adoption. As SpectrumAEC's founder and chief enabling officer, Nathan helps organizations and project teams successfully adopt change through executive strategy sessions and end user workshops. Nathan continues to support industry progression through conference presentations, academic papers, and as President of the Construction Progress Coalition. Additional Resources mentioned in this episode: What is Digital Delivery? National BIM Standards BuildingSMART BIM for Infrastructure Keep up with the Art of Construction (AOC) podcast on Instagram, Facebook, and LinkedIn! Subscribe to us and leave us a review on Apple Podcasts or Spotify!

"Take that step back and look at how the fabric that we exist in with our industries can change...I think there is so much room to embrace the opportunities, a challenge generally means there is money to be made as soon as you figure out how to do it." This podcast is a part of a series of episodes that will be coming out from now until Spring 2025 covering the AEC Summit in Austin, Texas April 23rd – 25th 2025. We encourage our listeners and partners to share and engage with us during this conference coverage! Use the promo code “AOCMFER” that will take $250 off registration. In this conversation, Devon Tilly and co-host Nathan Wood chat withNick Caravella in preparation for the  AEC Summit in Austin, Texas in April 2025! With over a decade of experience in the industry, Nick Caravella has a unique outlook by starting his career as an architect. His passion for using new technology on projects led him to a career in construction technology, where he worked in a series of product and community focused initiatives which further highlighted how companies could be enabling growth through optimizing their technology approach. Through this journey, Nick joined Avicado Construction Technology Services, where he currently works as the Director of Growth and Industry Strategy, as well as the Host/Producer of the company's construction technology podcast, Wired to Build. His background in architecture and expertise with technology provides a unique background that understands the needs of the AEC-O industry and how to apply the solutions being created to the problems we're trying to solve today. Nick holds a Bachelor of Architecture degree from the New Jersey Institute of Technology and is a registered Architect. Co-host Nathan Wood understands how rewarding the design and construction process can be when technology and culture embrace a new era of innovation. Nathan first earned his reputation as an industry thought leader in 2011, sharing his award-winning implementation of virtual design and construction (VDC) while working on integrated project delivery (IPD) healthcare projects. Nathan strives to share the best practices and lessons learned he's gathered from over 100 project teams spanning the US, Europe, and the Middle East. These experiences have taught him that when it comes to adopting technology in construction, it's not one size fits all. For that reason, Nathan founded SpectrumAEC with a clear goal — solving the human barriers to new process and technology adoption. As SpectrumAEC's founder and chief enabling officer, Nathan helps organizations and project teams successfully adopt change through executive strategy sessions and end user workshops. Nathan continues to support industry progression through conference presentations, academic papers, and as President of the Construction Progress Coalition. Additional listening to Bill Allen Episode! Listen to Nick on the ConTech Roadshow as a guest! Listen to Nick on the Building Bite as a guest! Listen to Nick on last year's WTB Epsiode on AECiS with Nathan! Avicado Research on how Owner's are Using Technology: Optimizing Construction Technology for Owners Keep up with the Art of Construction (AOC) podcast on Instagram, Facebook, and LinkedIn! Subscribe to us and leave us a review on Apple Podcasts or Spotify!

Esta semana ha terminado la semana del Cerebro. ¿Por qué es tan importante la investigación? Responde en la firma invitada José Ramón Pineda, investigador IPD de la Facultad de Medicina y Enfermería de la Universidad del País Vasco.

"In the spirit of getting the right people to Austin… Nathan...if 70 people are registered, then we will be a go for Coffee & Chaos at the Museum of Illusions in Austin" "That event was mind bending, and opened my eyes to how our position impacts our perspective." Help Nathan register 70 people so the mind bending trip to the Museum of Illusions will be a go! Register here! Use the promo code “AOCMFER” that will take $250 off registration. In this conversation, Devon Tilly and co-host Nathan Wood chat with Chad Pearson and Charlie Dunn in preparation for the  AEC Summit in Austin, Texas in April 2025! This podcast is a part of a series of episodes that will be coming out from now until Spring 2025 covering the AEC Summit in Austin, Texas April 23rd – 25th 2025. We encourage our listeners and partners to share and engage with us during this conference coverage! Charlie tells a good story. From lightning fast development on the Las Vegas strip, to oil fueled expansion in Edmonton, Alberta, to once in a generation energy plant upgrades throughout the Southeast, to global mission critical and life science construction for enterprise owners, he thrives in the challenging delivery gap between “as is” conditions and the “to be” designed state. His career highlights include the on-site project management of over 2.5 million square feet of new distribution space across North America with zero recordable injuries, and WANO (World Association of Nuclear Operators) recognition for the use of 4D technology in project delivery. He knows that projects succeed because of people—what they believe, strategy—as it supports creativity and innovation, and tools—to deliver value, drive out waste, and improve safety. Charlie's current working definition of a project storyteller is this: imagine that which is not, and take others there with you. He believes that construction may be the highest form of storytelling, for it transports humanity in a permanent way. Chad is a partner at Plexxis Software, where he helps deliver software to the ‘trades' while coaching teammates on performance under pressure. Outside of Plexxis, Chad is a Mixed Martial Arts and Wrestling coach. Prior to ConTech, Chad worked in Law Enforcement in Emergency Response, CIB (Criminal Investigation Bureau) and as an Outlaw Motorcycle Gang Liaison Officer. His formal training includes a Bachelor of Arts from University of Guelph, Crisis Resolution & tactical communication, CBRN (Chemical, Biological, Radiological & Nuclear Response), Police Defensive Tactics and Use of Force. Co-host Nathan Wood understands how rewarding the design and construction process can be when technology and culture embrace a new era of innovation. Nathan first earned his reputation as an industry thought leader in 2011, sharing his award-winning implementation of virtual design and construction (VDC) while working on integrated project delivery (IPD) healthcare projects. Nathan strives to share the best practices and lessons learned he's gathered from over 100 project teams spanning the US, Europe, and the Middle East. These experiences have taught him that when it comes to adopting technology in construction, it's not one size fits all. For that reason, Nathan founded SpectrumAEC with a clear goal — solving the human barriers to new process and technology adoption. As SpectrumAEC's founder and chief enabling officer, Nathan helps organizations and project teams successfully adopt change through executive strategy sessions and end user workshops. Nathan continues to support industry progression through conference presentations, academic papers, and as President of the Construction Progress Coalition. Keep up with the Art of Construction (AOC) podcast on Instagram, Facebook, and LinkedIn! Subscribe to us and leave us a review on Apple Podcasts or Spotify!

Dr. Neeraj Agarwal and Dr. Peter Hoskin discuss key abstracts in GU cancers from the 2025 ASCO Genitourinary Cancers Symposium, including novel therapies in prostate, bladder, and kidney cancer and the impact of combination therapies on patient outcomes. TRANSCSRIPT Dr. Neeraj Agarwal: Hello, and welcome to the ASCO Daily News Podcast. I'm Dr. Neeraj Agarwal, the director of the Genitourinary Oncology Program and professor of medicine at the Huntsman Cancer Institute at the University of Utah, and editor-in-chief of ASCO Daily News. Today, we'll be discussing practice-informing abstracts and other key advances in GU oncology featured at the 2025 ASCO Genitourinary Cancers Symposium. Joining me for this discussion is Dr. Peter Hoskin, the chair of this year's ASCO GU Symposium. Dr. Hoskin is a professor in clinical oncology in the University of Manchester and honorary consultant in clinical oncology at the Christie Hospital, Manchester, and University College Hospital London, in the United Kingdom. Our full disclosures are available in the transcript of this episode. Peter, thank you for joining us today. Dr. Peter Hoskin: Thank you so much, Neeraj. I am very pleased to be here. Dr. Neeraj Agarwal: The GU meeting highlighted remarkable advancements across the spectrum of GU malignancies. What stood out to you as the most exciting developments at the ASCO GU Symposium?  Dr. Peter Hoskin: The theme of this year's meeting was "Driving Innovation, Improving Patient Care," and this reflected ASCO GU's incredible milestone in GU cancer research over the years. We were thrilled to welcome almost 6,000 attendees on this occasion from over 70 countries, and most of them were attending in person and not online, although this was a hybrid meeting. Furthermore, we had more than 1,000 abstract submissions. You can imagine then that it fostered fantastic networking opportunities and facilitated valuable knowledge and idea exchanges among experts, trainees, and mentees. So, to start I'd like to come back to you for a second because the first day started with a focus on prostate cancer and some of the key clinical trials. And congratulations to you, Neeraj, on sharing the data from the TALAPRO-2 trial, which we were eagerly awaiting. I'd love to get your thoughts on the data that you presented. Could you tell us more about that trial, Abstract LBA18?  Dr. Neeraj Agarwal: Yes, Peter, I agree with you. It was such an exciting conference overall and thank you for your leadership of this conference. So, let's talk about the TALAPRO-2 trial. First of all, I would like to remind our audience that the combination of talazoparib plus enzalutamide was approved by the U.S. FDA in June 2023 in patients with metastatic castration-resistant prostate cancer harboring HRR gene alterations, after this combination improved the primary endpoint of radiographic progression-free survival compared to enzalutamide alone in the randomized, double-blind, placebo-controlled, multi-cohort phase 3 TALAPRO-2 trial. In the abstract I presented at ASCO GU 2025, we reported the final overall survival data, which was a key alpha-protected secondary endpoint in cohort 1, which enrolled an all-comer population of patients with mCRPC. So, at a median follow-up of around 53 months, in the intention-to-treat population, the combination of talazoparib plus enzalutamide significantly reduced the risk of death by 20% compared to enzalutamide alone, with a median OS of 45.8 months in the experimental arm versus 37 months in the control arm, which was an active control arm of enzalutamide. This improvement was consistent in patients with HRR alterations with a hazard ratio of 0.54 and in those with non-deficient or unknown HRR status, with a hazard ratio of 0.87. In a post hoc analysis, the hazard ratio for OS was 0.78 favoring the combination in those patients who did not have any HRR gene alteration in their tumors by both tissue and ctDNA testing. Consistent with the primary analysis, the updated rPFS data also favored the experimental arm with a median rPFS of 33.1 compared to 19.5 months in the control arm, and a hazard ratio of 0.667. No new safety signals were identified with extended follow-up. Thus, TALAPRO-2 is the first PARP inhibitor plus ARPI study to show a statistically significant and a clinically meaningful improvement in OS compared to standard-of-care enzalutamide as first-line treatment in patients with mCRPC unselected for HRR gene alterations. Dr. Peter Hoskin: Thank you, Neeraj. That's a great summary of the data presented and very important data indeed. There was another abstract also featured in the same session, Abstract 20, titled “Which patients with metastatic hormone-sensitive prostate cancer benefit more from androgen receptor pathway inhibitors? STOPCAP meta-analyses of individual participant data.” Neeraj, could you tell us more about this abstract? Dr. Neeraj Agarwal: Absolutely, I would be delighted to. So, in this meta-analysis, Dr. David Fischer and colleagues pooled individual participant data from different randomized phase 3 trials in the mHSPC setting to assess the potential ARPI effect modifiers and determine who benefits more from an ARPI plus ADT doublet. The primary outcome was OS for main effects and PFS for subgroup analyses. Prostate cancer specific survival was a sensitivity outcome. The investigators pooled data from 11 ARPI trials and more than 11,000 patients. Overall, there was a clear benefit of adding an ARPI on both OS and PFS, with hazard ratios of 0.66 and 0.51, respectively, representing a 13% and 21% absolute improvement at 5 years, respectively, with no clear difference by the class of agent. When stratifying the patients by age group, the effects of adding an ARPI on OS and PFS were slightly smaller in patients older than 75, than in those younger than 65, or aged between 65 and 75 years. Notably, in the trials assessing the use of abiraterone, we saw very little OS effects in the group of patients older than 75, however there was some benefit maintained in prostate-cancer specific survival, suggesting that other causes of death may be having an impact. The effects of the other ARPIs, or ‘lutamides' as I would call them, were similar across all three age subgroups on both OS and PFS. Therefore, the majority of patients with mHSPC benefit from the addition of ARPIs, and the benefits/risks of abiraterone and other ‘amides' must be considered in older patients.  Dr. Peter Hoskin: Thanks, Neeraj. Another great summary relevant to our day-to-day practice. Of course, there's ongoing collection of individual patient data from other key trials, which will allow robust comparison of ARPI doublet with triplet therapy (including docetaxel), guiding more personalized treatment.   Dr. Neeraj Agarwal: I agree with you, Peter, we need more data to help guide personalized treatment for patients with mHSPC and potentially guide de-escalation versus escalation strategies. Now, moving on to a different setting in prostate cancer, would you like to mention Abstract 17 titled, “Overall survival and quality of life with Lu-PSMA-617 plus enzalutamide versus enzalutamide alone in poor-risk, metastatic, castration-resistant prostate cancer in ENZA-p (ANZUP 1901),” presented by Dr. Louise Emmett? Dr. Peter Hoskin: Of course I will. So, ENZA-p was a multicenter, open-label, randomized, phase 2 trial conducted in Australia. It randomized 163 patients into adaptive doses (2 or 4 cycles) of Lu-PSMA-617 plus enzalutamide versus enzalutamide alone as first-line treatment in PSMA-PET-CT-positive, poor-risk, mCRPC. The interim analysis of ENZA-p with median follow-up 20 months showed improved PSA-progression-free survival with the addition of Lu-PSMA-617 to enzalutamide. Here, the investigators reported the secondary outcomes, overall survival, and health-related quality of life (HRQOL). After a median follow up of 34 months, overall survival was longer in the combination arm compared to the enzalutamide arm, with a median OS of 34 months compared to 26 months; with an HR of 0.55. Moreover, the combination improved both deterioration-free survival and health-related quality of life indicators for pain, fatigue, physical function, and overall health and quality of life compared to the control arm. Consistent with the primary analysis, the rPFS also favored the experimental arm with a median rPFS of 17 months compared to 14 months with a HR of 0.61. So, the addition of LuPSMA improved overall survival, and HRQOL in patients with high-risk mCRPC. Dr. Neeraj Agarwal: Thank you, Peter. Great summary, and promising results with Lu-177 and ARPI combination in first line treatment for mCRPC among patients who had two or more high risk features associated with early enzalutamide failure. Before we move on to bladder cancer, would you like to tell us about Abstract 15 titled, “World-wide oligometastatic prostate cancer (omPC) meta-analysis leveraging individual patient data (IPD) from randomized trials (WOLVERINE): An analysis from the X-MET collaboration,” presented by Dr. Chad Tang?  Dr. Peter Hoskin: Sure. So, with metastatic-directed therapy (MDT), we have a number of phase 2 studies making up the database, and the X-MET collaboration aimed to consolidate all randomized data on oligometastatic solid tumors. This abstract presented pooled individual patient data from all the published trials involving patients with oligometastatic prostate cancer who received MDT alongside standard of care (SOC) against SOC alone. The analysis included data from five trials, encompassing 472 patients with oligometastatic prostate cancer, and followed for a median of 41 months. Patients were randomly assigned in a 1:1 ratio to receive either MDT plus SOC or SOC alone. The addition of MDT significantly improved PFS. The median PFS was 32 months with MDT compared to 14.9 months with SOC alone, with an HR of 0.45. Subgroup analyses further confirmed the consistent benefits of MDT across different patient groups. Regardless of factors like castration status, receipt of prior primary treatment, stage, or number of metastases, MDT consistently improved PFS. In patients with mHSPC, MDT significantly delayed the time to castration resistance by nine months, extending it to a median of 72 months compared to 63 months in the SOC group with an HR of 0.58. In terms of OS, the addition of MDT improved the 48-month survival rate by 12%, with OS rates of 87% in the MDT+SOC group compared to 75% in the SOC alone group. Dr. Neeraj Agarwal: Thank you, Peter. These data demonstrate that adding MDT to systemic therapy significantly improves PFS, rPFS, and castration resistance-free survival, reinforcing its potential role in the treatment of oligometastatic prostate cancer. So, let's switch gears to bladder cancer and start with Abstract 658 reporting the OS analysis of the CheckMate-274 trial. Would you like to tell us about this abstract?  Dr. Peter Hoskin: Yes, sure, Neeraj. This was presented by Dr. Matt Milowsky, and it was additional efficacy outcomes, including overall survival, from the CheckMate-274 trial which evaluated adjuvant nivolumab versus placebo in patients with high-risk muscle-invasive bladder cancer after radical surgery. The phase 3 trial previously demonstrated a significant improvement in disease-free survival with nivolumab. With a median follow-up of 36.1 months, disease-free survival was longer with nivolumab compared to placebo across all patients with muscle-invasive bladder cancer, reducing the risk of disease recurrence or death by 37%. Among patients who had received prior neoadjuvant cisplatin-based chemotherapy, nivolumab reduced this risk by 42%, whilst in those who had not received chemotherapy, the risk was reduced by 31%. Overall survival also favored nivolumab over placebo, reducing the risk of death by 30% in all patients with muscle-invasive bladder cancer and by 52% in those with tumors expressing PD-L1 at 1% or higher. Among patients who had received prior neoadjuvant chemotherapy, nivolumab reduced the risk of death by 26%, whilst in those who had not received chemotherapy, the risk was reduced by 33%. Alongside this, the safety profile remained consistent with previous findings. Dr. Neeraj Agarwal: Thank you, Peter, for such a nice overview of this abstract. These results reinforce adjuvant nivolumab as a standard of care for high-risk muscle-invasive bladder cancer, offering the potential for a curative outcome for our patients. Dr. Peter Hoskin: I agree with you Neeraj. Perhaps you would like to mention Abstract 659 titled, “Additional efficacy and safety outcomes and an exploratory analysis of the impact of pathological complete response (pCR) on long-term outcomes from NIAGARA.” Dr. Neeraj Agarwal: Of course. Dr. Galsky presented additional outcomes from the phase 3 NIAGARA study, which evaluated perioperative durvalumab combined with neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer. The study previously demonstrated a significant improvement in event-free survival and overall survival with durvalumab compared to chemotherapy alone, with a manageable safety profile and no negative impact on the ability to undergo radical cystectomy. Among the 1,063 randomized patients, those who received durvalumab had a 33% reduction in the risk of developing distant metastases or death and a 31% reduction in the risk of dying from bladder cancer compared to those who received chemotherapy alone. More patients who received durvalumab achieved a pathological complete response at the time of surgery with 37% compared to 28% in the chemotherapy-alone group. Patients who achieved a pathological complete response had better event-free survival and overall survival compared to those who did not. In both groups, durvalumab provided additional survival benefits, reducing the risk of disease progression or death by 42% and the risk of death by 28% in patients with a pathological complete response, while in those patients without a pathological complete response, the risk of disease progression or death was reduced by 23% and the risk of death by 16% when durvalumab was added to the chemotherapy. Immune-mediated adverse events occurred in 21% of patients in the durvalumab group compared to 3% in the chemotherapy-alone group, with grade 3 or higher events occurring in 3% compared to 0.2%. The most common immune-related adverse events included hypothyroidism in 10% of patients treated with durvalumab compared to 1% in the chemotherapy-alone group, and hyperthyroidism in 3% versus 0.8%. At the time of the data cutoff, these adverse events had resolved in 41% of affected patients in the durvalumab group and 44% in the chemotherapy-alone group. Dr. Peter Hoskin: Thank you, Neeraj, for the great summary. These findings further support the role of perioperative durvalumab as a potential standard of care for patients with muscle-invasive bladder cancer. Dr. Neeraj Agarwal: I concur with your thoughts, Peter. Before wrapping up the bladder cancer section, would you like to mention Abstract 664 reporting updated results from the EV-302 trial, which evaluated enfortumab vedotin in combination with pembrolizumab compared to chemotherapy as first-line treatment for patients with previously untreated locally advanced or metastatic urothelial carcinoma? Dr. Peter Hoskin: Yes, of course. Dr. Tom Powles presented updated findings from the EV-302 study, and in this abstract presented 12 months of additional follow-up for EV-302 (>2 y of median follow-up) and an exploratory analysis of patients with confirmed complete response (cCR). The study had a median follow-up of 29.1 months and previously demonstrated significant improvements in progression-free survival and overall survival with enfortumab vedotin and pembrolizumab. This is now the standard of care in global treatment guidelines. Among the 886 randomized patients, enfortumab vedotin and pembrolizumab reduced the risk of disease progression or death by 52% and the risk of death by 49% compared to chemotherapy. The survival benefit was consistent regardless of cisplatin eligibility or the presence of liver metastases. The confirmed objective response rate was higher with enfortumab vedotin and pembrolizumab at 67.5% compared to 44.2% with chemotherapy. The median duration of response was 23.3 months with enfortumab vedotin and pembrolizumab compared to 7.0 months with chemotherapy. A complete response was achieved in 30.4% of patients in the enfortumab vedotin and pembrolizumab group compared to 14.5% in the chemotherapy group, with the median duration of complete response not yet reached in the enfortumab vedotin and pembrolizumab group compared to 15.2 months in the chemotherapy group. Severe treatment-related adverse events occurred in 57.3% of patients treated with enfortumab vedotin and pembrolizumab compared to 69.5% in the chemotherapy group, while in patients who achieved a complete response, severe adverse events occurred in 61.7% of those treated with enfortumab vedotin and pembrolizumab compared to 71.9% with chemotherapy. Treatment-related deaths were reported in 1.1% of patients treated with enfortumab vedotin and pembrolizumab compared to 0.9% with chemotherapy, with no treatment-related deaths occurring in those who achieved a complete response. These findings clearly confirm the durable efficacy of enfortumab vedotin and pembrolizumab, reinforcing its role as the standard of care for the first-line treatment of patients with locally advanced or metastatic urothelial carcinoma, and no new safety concerns have been identified. Dr. Neeraj Agarwal: Thank you for this great summary. Moving on to kidney cancer, let's talk about Abstract 439 titled, “Nivolumab plus cabozantinib (N+C) vs sunitinib (S) for previously untreated advanced renal cell carcinoma (aRCC): Final follow-up results from the CheckMate-9ER trial.” Dr. Peter Hoskin: Sure. Dr. Motzer presented the final results from the phase 3 CheckMate-9ER trial, which compared the combination of cabozantinib and nivolumab against sunitinib in previously untreated advanced renal cell carcinoma. The data after more than five years follow-up show that the combination therapy provided sustained superior efficacy compared to sunitinib. In terms of overall survival, we see an 11-month improvement in median OS, 46.5 months for the cabo-nivo versus 35.5 months for sunitinib and a 42% reduction in the risk of disease progression or death, with median progression-free survival nearly doubling – that's 16.4 months in the combination group and 8.3 months with sunitinib. Importantly, the safety profile was consistent with the known safety profiles of the individual medicines, with no new safety concerns identified. Dr. Neeraj Agarwal: Great summary, Peter. These data further support the efficacy of cabo-nivo combination therapy in advanced renal cell carcinoma, which is showing a 11-month difference in overall survival. Dr. Peter Hoskin: Neeraj, before wrapping up this podcast, would you like to tell us about Abstract 618? This is titled “Prospective COTRIMS (Cologne trial of retroperitoneal lymphadenectomy in metastatic seminoma) trial: Final results.” Dr. Neeraj Agarwal: Sure, Peter. I would be delighted to. Dr Heidenrich from the University of Cologne in Germany presented the COTRIMS data evaluating retroperitoneal LN dissection in patients with clinical stage 2A/B seminomas. Seminomas are classified as 2A or B when the disease spreads to the retroperitoneal lymph nodes of up to 2 cm (CS IIA) or of more than 2 cm to up to 5 cm (CS 2B) in maximum diameter, respectively. They account for 10-15% of seminomas and they are usually treated with radiation and chemotherapy. However, radiation and chemo can be associated with long-term toxicities such as cardiovascular toxicities, diabetes, solid cancers, leukemia, particularly for younger patients. From this standpoint, Dr Heidenrich and colleagues evaluated unilateral, modified template, nerve-sparing retroperitoneal lymph node dissection as a less toxic alternative compared to chemo and radiation. They included 34 patients with negative AFP, beta-HCG, and clinical stage 2A/B seminomas. At a median follow-up of 43.2 months, the trial demonstrated great outcomes: a 99.3% treatment-free survival rate and 100% overall survival, with only four relapses. Antegrade ejaculation was preserved in 88% of patients, and severe complications such as grade 3 and 4 were observed in 12% of patients. Pathological analysis revealed metastatic seminoma in 85% of cases, with miR371 being true positive in 23 out of 24 cases and true negative in 100% of cases. It appears to be a valid biomarker for predicting the presence of lymph node metastases. These findings highlight retroperitoneal lymph node dissection is feasible; it has low morbidity, and excellent oncologic outcomes, avoiding overtreatment in 80% of patients and sparing unnecessary chemotherapy or radiotherapy in 10-15% of cases. Dr. Peter Hoskin: Great summary and important data on retroperitoneal lymphadenectomy in metastatic seminoma. These findings will help shape clinical practice. Any final remarks before we conclude today's podcast? Dr. Neeraj Agarwal: Before wrapping up this podcast, I would like to say that we have reviewed several abstracts addressing prostate, bladder, kidney cancers, and seminoma, which are impacting our medical practices now and in the near future. Peter, thank you for sharing your insights with us today. These updates are undoubtedly exciting for the entire GU oncology community, and we greatly appreciate your valuable contribution to the discussion and your leadership of the conference. Many thanks. Dr. Peter Hoskin: Thank you, Neeraj. Thank you for the opportunity to share this information more widely. I'm aware that whilst we have nearly 6,000 delegates, there are many other tens of thousands of colleagues around the world who need to have access to this information. And it was a great privilege to chair this ASCO GU25. So, thank you once again, Neeraj, for this opportunity to share more of this information that we discussed over those few days. Dr. Neeraj Agarwal: Thank you, Peter. And thank you to our listeners for joining us today. You will find links to the abstracts discussed today on the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer: 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.  Find out more about today's speakers:   Dr. Neeraj Agarwal    @neerajaiims    Dr. Peter Hoskin Follow ASCO on social media:      @ASCO on Twitter      ASCO on Bluesky  ASCO on Facebook      ASCO on LinkedIn      Disclosures: Dr. Neeraj Agarwal: Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb, AstraZeneca, Nektar, Lilly, Bayer, Pharmacyclics, Foundation Medicine, Astellas Pharma, Lilly, Exelixis, AstraZeneca, Pfizer, Merck, Novartis, Eisai, Seattle Genetics, EMD Serono, Janssen Oncology, AVEO, Calithera Biosciences, MEI Pharma, Genentech, Astellas Pharma, Foundation Medicine, and Gilead Sciences Research Funding (Institution): Bayer, Bristol-Myers Squibb, Takeda, Pfizer, Exelixis, Amgen, AstraZeneca, Calithera Biosciences, Celldex, Eisai, Genentech, Immunomedics, Janssen, Merck, Lilly, Nektar, ORIC Pharmaceuticals, Crispr Therapeutics, Arvinas Dr. Peter Hoskin: Research Funding (Institution): Varian Medical Systems, Astellas Pharma, Bayer, Roche, Pfizer, Elekta, Bristol Myers  

In a new pharmaphorum podcast, web editor Nicole Raleigh speaks with two PharmaLex experts about navigating complex R&D processes to unleash the next wave of biopharma breakthroughs. PharmaLex's Dr Christian Schneider, VP & Chief Medical Officer, Clinical Development Services, together with Dr Christelle Boileau, Director of Regulatory Development Strategy and IPD solution lead at PharmaLex, which is part of Cencora, explore the many challenges faced across the clinical trial landscape when it comes to new therapies, including ATMP development. From preclinical to market access and regulatory considerations, Dr Boileau warns that development is not a linear process, and for both an early-as-possible strategy is paramount. Comparing classical paradigms with the new, traditional endpoints need to be reassessed – for example, when defining dosage – says Dr Schneider. You can listen to episode 165a of the pharmaphorum podcast in the player below, download the episode to your computer, or find it - and subscribe to the rest of the series - in iTunes, Spotify, Amazon Music, Podbean, and pretty much wherever you get your other podcasts!

As a new year kicks off, it is natural to look ahead with a bit, or a lot, of uncertainty.  What risks lie ahead and how can they be managed?  We invite Michael Dubreuil, managing partner of PTAG, to join us on to the show.  He works on projects that can span decades!In this episode, Michael dives into collaborative contracting, which basically is IPD (integrated project delivery) on steroids.  This powerful method of contracting provides balance, stability, and trust in the project team, providing confidence in risk sharing and management.  Have you ever wondered how oil and gas projects, or nuclear projects get built? Let's learn how MEGA collaboration on MEGA projects defines certainty in any situation.  

ஆஸ்திரேலியாவில் Invasive pneumococcal disease (IPD) என்ற உயிருக்கு ஆபத்தான பாக்டீரியா நோய்த்தொற்றின் பரவல் விகிதங்கள் 2004 ஆம் ஆண்டுடன் ஒப்பிடும்போது மிக உயர்ந்த மட்டத்தில் உள்ளதாக எச்சரிக்கப்பட்டுள்ளது. இது குறித்த செய்தியை எடுத்துவருகிறார் றேனுகா துரைசிங்கம்.

"Double your time, save four times the frustration." In this conversation, Devon Tilly and co-host Nathan Wood chat with Chad Pearson in preparation for the  AEC Summit in Austin, Texas in April 2025! This podcast is a part of a series of episodes that will be coming out from now until Spring 2025 covering the AEC Summit in Austin, Texas April 23rd - 25th 2025. We encourage our listeners and partners to share and engage with us during this conference coverage! Keep up with the Art of Construction (AOC) podcast on Instagram, Facebook, LinkedIn, and Youtube! Submit a Team Topic for the AEC Summit 2025!  Currently, Chad is a partner at Plexxis Software, where he helps deliver software to the ‘trades' while coaching teammates on performance under pressure. Outside of Plexxis, Chad is a Mixed Martial Arts and Wrestling coach. Prior to ConTech, Chad worked in Law Enforcement in Emergency Response, CIB (Criminal Investigation Bureau) and as an Outlaw Motorcycle Gang Liaison Officer. His formal training includes a Bachelor of Arts from University of Guelph, Crisis Resolution & tactical communication, CBRN (Chemical, Biological, Radiological & Nuclear Response), Police Defensive Tactics and Use of Force. Nathan Wood understands how rewarding the design and construction process can be when technology and culture embrace a new era of innovation. Nathan first earned his reputation as an industry thought leader in 2011, sharing his award-winning implementation of virtual design and construction (VDC) while working on integrated project delivery (IPD) healthcare projects. Nathan strives to share the best practices and lessons learned he's gathered from over 100 project teams spanning the US, Europe, and the Middle East. These experiences have taught him that when it comes to adopting technology in construction, it's not one size fits all. For that reason, Nathan founded SpectrumAEC with a clear goal — solving the human barriers to new process and technology adoption. As SpectrumAEC's founder and chief enabling officer, Nathan helps organizations and project teams successfully adopt change through executive strategy sessions and end user workshops. Nathan continues to support industry progression through conference presentations, academic papers, and as President of the Construction Progress Coalition. Video: ‘Positive Proximity' and the not so obvious consequences of physically fragmented teams Video: Tips for Construction Tech Selection and Adoption Video: Using Police tactics to negotiate technology agreements Tips for Team Cohesion prior to tech adoption! Subscribe to us and leave us a review on Apple Podcasts or Spotify!

“One thing that I always say is you have to build a plan, build a strategic plan with actionable and attainable goals - and look for those opportunities to collaborate...it's a game changer." In this conversation, Devon Tilly and co-host Nathan Wood chat with Denise Devine from Veloris Consulting about her background and the upcoming AEC Summit in Austin, Texas in April 2025! This podcast is a part of a series of episodes that will be coming out from now until Spring 2025 covering the AEC Summit in Austin, Texas April 23rd - 25th 2025. We encourage our listeners and partners to share and engage with us during this conference coverage! Keep up with the Art of Construction (AOC) podcast on Instagram, Facebook, LinkedIn, and Youtube! Submit a Team Topic for the AEC Summit 2025!  Denise has over 20 years of expertise in growth strategy and operational efficiencies and serves the industry as a consultant, researcher, author and speaker as Founder of Veloris Consulting. Her most recent work was the 2024 edition of the Construction Technology Report for NECA, MCAA and SMACNA after supporting the research and keynote presentation at the 2024 MEP Innovation Conference (pending publication). She is currently co-authoring a curriculum and textbook on AI for the Construction Industry with The New School of Architecture. To further support the industry, Denise also holds a position as Senior Manager with Continuum Advisory Group and she serves as the Construction Progress Coalition's Communication Director, Chair of Women Construction Coalition's, Julia Morgan Society, and is the Treasurer of CMAA San Diego's DEIB committee. Denise's commitment to continued education underscores her passion for optimizing the industry and supporting contractors nationwide. Nathan Wood understands how rewarding the design and construction process can be when technology and culture embrace a new era of innovation. Nathan first earned his reputation as an industry thought leader in 2011, sharing his award-winning implementation of virtual design and construction (VDC) while working on integrated project delivery (IPD) healthcare projects. Nathan strives to share the best practices and lessons learned he's gathered from over 100 project teams spanning the US, Europe, and the Middle East. These experiences have taught him that when it comes to adopting technology in construction, it's not one size fits all. For that reason, Nathan founded SpectrumAEC with a clear goal — solving the human barriers to new process and technology adoption. As SpectrumAEC's founder and chief enabling officer, Nathan helps organizations and project teams successfully adopt change through executive strategy sessions and end user workshops. Nathan continues to support industry progression through conference presentations, academic papers, and as President of the Construction Progress Coalition. Subscribe to us and leave us a review on Apple Podcasts or Spotify!

Our guest this week is a Young Pro Ripper from Newport. When he isn't chasing swells or travelin he holds down a salesman position at one of the best shops in the world Surfside Sports! He is one of very few to pack some thick tubes out at Cylinders when it is pumping, resulting in a couple of concussions and a GoPro Wedge Entry Clip of the Year. Make sure to check his sick edit charging some Keggers at Nias in the IPD movie “Passport”. He is a humble cool kid, with tons of talent, and has some Grande Cojones. We welcome to the show Ty “TY-BORG“ Burgess.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

UP.FIT, a division of exterior and interior upgrader Unplugged Performance, announced that it deployed a Tesla Cybertruck upfitted for law enforcement in California. The project was completed in collaboration with the Irvine Police Department and Tesla and will be used as part of the department's Drug Abuse Resistance Education (DARE) program. The Cybertruck joins the DARE program's list of unique vehicles, which includes other pick-ups and a PT Cruiser with IPD decals.Download and listen to the audio version below and click here to subscribe to the Today in Manufacturing podcast.

Wie stellst du dir die Zukunft der Service-Hotlines vor ☎️

Presented in partnership with Fertility and Sterility onsite at the 2024 ANZSREI meeting in Sydney, Australia.  The ANZSREI 2024 debate discussed whether patients with unexplained infertility should go straight to IVF. Experts on both sides weighed the effectiveness, cost, and psychological impact of IVF versus alternatives like IUI. The pro side emphasized IVF's high success rates and diagnostic value, while the con side argued for less invasive, cost-effective options. The debate highlighted the need for individualized care, with no clear consensus reached among the audience. View Fertility and Sterility at https://www.fertstert.org/ TRANSCRIPT: Welcome to Fertility and Sterility On Air, the podcast where you can stay current on the latest global research in the field of reproductive medicine. This podcast brings you an overview of this month's journal, in-depth discussion with authors, and other special features. F&S On Air is brought to you by Fertility and Sterility family of journals in conjunction with the American Society for Reproductive Medicine, and is hosted by Dr. Kurt Barnhart, Editor-in-Chief, Dr. Eve Feinberg, Editorial Editor, Dr. Micah Hill, Media Editor, and Dr. Pietro Bordoletto, Interactive Associate-in-Chief. I'd just like to say welcome to our third and final day of the ANZSREI conference. We've got our now traditional F&S podcast where we've got an expert panel, we've got our international speaker, Pietro, and we've got a wonderful debate ahead of us. This is all being recorded. You're welcome, and please think of questions to ask the panel at the end, because it's quite an interactive session, and we're going to get some of the best advice on some of the really controversial areas, like unexplained infertility. Hi, everyone. Welcome to the second annual Fertility and Sterility Journal Club Global, coming to you live from the Australia and New Zealand Society for Reproductive Endocrinology and Infertility meeting. I think I speak on behalf of everyone at F&S that we are so delighted to be here. Over the last two years, we've really made a concerted effort to take the podcast on the road, and this, I think, is a nice continuation of that. For the folks who are tuning in from home and listening to this podcast after the fact, the Australia and New Zealand Society for Reproductive Endocrinology is a group of over 100 certified reproductive endocrinologists across Australia and New Zealand, and this is their annual meeting live in Sydney, Australia. Today's debate is a topic that I think has vexed a lot of individuals, a lot of patients, a lot of professional groups. There's a fair amount of disagreement, and today we're going to try to unpack a little bit of unexplained infertility, and the question really is, should we be going straight to IVF? As always, we try to anchor to literature, and there are two wonderful documents in fertility and sterility that we'll be using as our guide for discussion today. The first one is a wonderful series that was published just a few months ago in the May issue, 2024, that is a views and reviews section, which means there's a series of three to five articles that kind of dig into this topic in depth. And the second article is our professional society guideline, the ASRM Committee Opinion, entitled Evidence-Based Treatments for Couples with Unexplained Infertility, a guideline. The format for today's discussion is debate style. We have a group of six experts, and I've asked them to randomly assign themselves to a pro and a con side. So I'll make the caveat here that the things that they may be saying, positions they may be trying to influence us on, are not necessarily things that they believe in their academic or clinical life, but for the purposes of a rich debate, they're going to have to be pretty deliberate in convincing us otherwise. I want to introduce my panel for today. We have on my immediate right, Dr. Raewyn Tierney. She's my co-moderator for tonight, and she's a practicing board-certified fertility specialist at IVF Australia. And on my immediate left, we have the con side. Going from left to right, Dr. Michelle Quick, practicing board-certified fertility specialist at IVF Australia. Dr. Robert LaHood, board-certified reproductive endocrinologist and clinical director of IVF Australia here in Sydney. And Dr. Clara Bothroyd, medical director at Care Fertility and the current president of the Asia Pacific Initiative in Reproduction. Welcome. On the pro side, going from right to left, I have Dr. Aurelia Liu. She is a practicing board-certified fertility specialist, medical director of Women's Health Melbourne, and clinical director at Life Fertility in Melbourne. Dr. Marcin Stankiewicz, a practicing board-certified fertility specialist and medical director at Family Fertility Centre in Adelaide. And finally, but certainly not least, the one who came with a tie this morning, Dr. Roger Hart, who is a professor of reproductive medicine at the University of Western Australia and the national medical director of City Fertility. Welcome, pro side. Thank you.  I feel naked without it. APPLAUSE I've asked both sides to prepare opening arguments. Think of this like a legal case. We want to hear from the defence, we want to hear from the plaintiffs, and I'm going to start with our pro side. I'd like to give them a few minutes to each kind of introduce their salient points for why we should be starting with IVF for patients with unexplained infertility. Thanks, Pietro. To provide a diagnosis of unexplained infertility, it's really a reflection of the degree investigation we've undertaken. I believe we all understand that unexplained infertility is diagnosed in the presence of adequate intercourse, normal semen parameters, an absence ovulatory disorder, patent fallopian tubes, and a normal detailed pelvic ultrasound examination. Now, the opposing team will try to convince you that I have not investigated the couple adequately. Personally, I'm affronted by that suggestion. But what possible causes of infertility have I not investigated? We cannot assess easily sperm fertilising capability, we cannot assess oocyte quality, oocyte fertilisation potential, embryonic development, euploidy rate, and implantation potential. Surely these causes of unexplained fertility will only become evident during an IVF cycle. As IVF is often diagnostic, it's also a therapeutic intervention. Now, I hear you cry, what about endometriosis? And I agree, what about endometriosis? Remember, we're discussing unexplained infertility here. Yes, there is very good evidence that laparoscopic treatment for symptomatic patients with endometriosis improves pelvic pain, but there is scant evidence that a diagnostic laparoscopy and treating any minor disease in the absence of pain symptoms will improve the chance of natural conception, or to that matter, improve the ultimate success of IVF. Indeed, in the absence of endometriomas, there is no negative impact on the serum AMH level in women with endometriosis who have not undergone surgery. Furthermore, there is no influence on the number of oocytes collected in an IVF cycle, the rate of embryonic aneuploidy, and the live birth rate after embryo transfer. So why put the woman through a painful, possibly expensive operation with its attendant risks as you're actually delaying her going straight to IVF? What do esteemed societies say about a diagnostic laparoscopy in the setting of unexplained infertility? The ESHRE guidelines state routine diagnostic laparoscopy is not recommended for the diagnosis of unexplained infertility. Indeed, our own ANZSREI consensus statement says that for a woman with a minimal and mild endometriosis, that the number of women needed to treat for one additional ongoing pregnancy is between 3 and 100 women with endometriosis. Is that reasonable to put an asymptomatic woman through a laparoscopy for that limited potential benefit? Now, regarding the guidelines for unexplained infertility, I agree the ASRM guidelines do not support IVF as a first-line therapy for unexplained infertility for women under 37 years of age. What they should say, and they don't, is that it is assumed that she is trying for her last child. There's no doubt if this is her last child, if it isn't her last child, sorry, she will be returning, seeking treatment, now over 37 years of age, where the guidelines do state there is good evidence that going straight to IVF may be associated with higher pregnancy rates, a shorter time to pregnancy, as opposed to other strategies. They then state it's important to note that many of these included studies were conducted in an area of low IVF success rates than those currently observed, which may alter this approach, suggesting they do not even endorse their own recommendations. The UK NICE guidelines, what do they say for unexplained infertility? Go straight to IVF. So while you're listening to my esteemed colleagues on my left speaking against the motion, I'd like to be thinking about other important factors that my colleagues on my right will discuss in more detail. Consider the superior efficacy of IVF versus IUI, the excellent safety profile of IVF and its cost-effectiveness. Further, other factors favouring a direct approach to IVF in the setting of unexplained infertility are what is the woman's desired family? We should not be focusing on her first child, we should be focusing on giving her the family that she desires and how we can minimise her inconvenience during treatment, as this has social, career and financial consequences for those impediments for her while we attempt to help her achieve her desired family. Thank you. APPLAUSE I think the young crowd would say that that was shots fired. LAUGHTER Con side? We're going to save the rebuttal for the time you've allocated to that, but first I want to put the case about unexplained infertility. Unexplained infertility in 2024 is very different to what it was 10 and 20 years ago when many of the randomised controlled trials that investigated unexplained infertility were performed. The armamentarium of investigative procedures and options that we have has changed, as indeed has our understanding of the mechanisms of infertility. So much so that that old definition of normal semen analysis, normal pelvis and ovulatory, which I think was in Roy Homburg's day, is now no longer fit for purpose as a definition of unexplained infertility. And I commend to you ICMART's very long definition of unexplained infertility, which really relies on a whole lot of things, which I'm going to now take you through what we need to do. It is said, or was said, that 30% of infertility was unexplained. I think it's way, way less than that if we actually look at our patients, both of them, carefully with history and examination and directed tests, and you will probably reduce that to about 3%. Let me take you through female age first. Now, in the old trials, some of the women recruited were as old as 42. That is not unexplained infertility. We know about oocyte aneuploidy and female ageing. 41, it's not unexplained. 40, it's not unexplained. 39, it's not unexplained. And I would put it to you that the cut-off where you start to see oocyte aneuploidy significantly constraining fertility is probably 35. So unexplained infertility has to, by definition, be a woman who is less than 35. I put that to you. Now, let's look at the male. Now, what do we know about the male, the effect of male age on fertility? We know that if the woman is over 35, and this is beautiful work that's really done many years ago in Europe, that if the woman is over 35 and the male is five years older than her, her chance of natural conception is reduced by a further 30%. So I put it to you that, therefore, the male age is relevant. And if she's 35 and has a partner who's 35 years older than her or more, it's not unexplained infertility. It's related to couple age. Now, we're going to... So that's age. Now, my colleagues are going to take you through a number of treatment interventions other than IVF, which we can do with good effect if we actually make the diagnosis and don't put them into the category of unexplained infertility. You will remember from the old trials that mild or moderate or mild or minimal endometriosis was often included, as was mild male factor or seminal fluid abnormalities. These were really multifactorial infertility, and I think that's the take-home message, that much of what we call unexplained is multifactorial. You have two minor components that act to reduce natural fecundability. So I now just want to take you through some of the diagnoses that contribute to infertility that we may not, in our routine laparoscopy and workup, we may not pick up and have previously been called unexplained infertility. For instance, we know that adenomyosis is probably one of the mechanisms by which endometriosis contributes to infertility. Chronic endometritis is now emerging as an operative factor in infertility, and that will not be diagnosed easily. Mild or minimal endometriosis, my colleagues will cover. The mid-cycle scan will lead you to the thin endometrium, which may be due to unexpected adhesive disease, but also a thin endometrium, which we know has a very adverse prognostic factor, may be due to long-term progestin contraception. We are starting to see this emerge. Secondary infertility after a caesarean section may be due to an isthma seal, and we won't recognise that unless we do mid-cycle scans. That's the female. Let's look at the male. We know now that seminal fluid analysis is not a good predictor of male fertility, and there is now evidence from Ranjith Ramasamy's work that we are missing clinical varicoceles because we failed to examine the male partner. My colleagues will talk more about that. We may miss DNA fragmentation, which again may contribute via the basic seminal fluid analysis. Now, most of these diagnoses can be made or sorted out or excluded within one or two months of your detailed assessment of both partners by history and examination. So it's not straight to IVF, ladies and gentlemen. It's just a little digression, a little lay-by, where you actually assess the patient thoroughly. She did not need a tie for that rebuttal. LAUGHTER Prasad. Thank you. Well, following from what Professor Hart has said, I'm going to show that IVF should be a go-to option because of its effectiveness, cost-effectiveness and safety. Now, let me first talk about the effectiveness, and as this is an interaction session, I would like to ask the audience, please, by show of hands, to show me how many of you would accept a medical treatment or buy a new incubator if it had a 94% chance of failure? Well, let the moderator please note that no hands have been raised. Thank you very much. Yet, the chance of live birth in Australian population following IUI is 6%, where, after IVF, the live birth is 40%. Almost seven times more. Now, why would we subject our patients to something we ourselves would not choose? Similarly, findings were reported from international studies that the hazard ratio of 1.25 favouring immediate IVF, and I will talk later about why it is important from a safety perspective. Cost-effectiveness. And I quote ESHRE guidelines. The costs, treatment options have not been subject to robust evaluations. Now, again, I would like to ask the audience, this time it's an easy question, how many of you would accept as standard an ongoing pregnancy rate of at least 38% for an average IVF cycle? Yeah, hands up. All right, I've got three-quarters of the room. OK. Well, I could really rest my case now, as we have good evidence that if a clinic has got an ongoing pregnancy rate of 38% or higher with IVF with single embryo transfer, then it is more effective, more cost-effective, and should be a treatment of choice. And that evidence comes from the authors that are sitting in this room. Again, what would the patients do? If the patients are paying for the treatment, would they do IUI? Most of them would actually go straight to IVF. And we also have very nice guidelines which advise against IUI based on cost-effectiveness. Another factor to mention briefly is the multiple births, which cost five to 20 times more than singleton. The neonatal cost of a twin birth costs about five times more than singletons, and pregnancy with delivery of triplets or more costs nearly 20 times. Now, the costs that I'm going to quote are in American dollars and from some time ago, from Fertility and Sterility. However, the total adjusted all healthcare costs for a single-dom delivery is about US$21,000, US$105,000 for twins, and US$400,000 for triplets and more. Then the very, very important is the psychological cost of the high risk of failure with IUI. Now, it is well established that infertility has a psychological impact on our patients. Studies have shown that prolonged time to conception extends stress, anxiety, and depression, and sexual functioning is significantly negatively impacted. Literature shows that 56% of women and 32% of men undergoing fertility treatment report significant symptoms of depression, and 76% of women and 61% of men report significant symptoms of anxiety. Shockingly, it is reported that 9.4% of women reported having suicidal thoughts or attempts. The longer the treatment takes, the more our patients display symptoms of distress, depression, and anxiety. Safety. Again, ESHRE guideline says the safety of treatment options have not been subjected to robust evaluation. But let me talk you through it. In our Australian expert hands, IVF is safe, with the risk of complications of ectopic being about 1 in 1,500 and other risks 1 in 3,000. However, let's think for a moment on impact of multiple births. A multiple pregnancy has significant psychological, physical, social, and financial consequences, which I can go further into details if required. I just want to mention that the stillbirth rate increases from under 1% for singleton pregnancies to 4.5% for twins and 8.3% for higher-order multiples, and that multiple pregnancies have potential long-term adverse health outcomes for the offspring, such as the increased risk of health issues through their life, increased learning difficulties, language delay, and attention and behavior problems. The lifelong disability is over 25% for babies weighing less than 1 kilogram at delivery. And please note that the quoted multiple pregnancy rates with IUI can reach up to 33%, although in expert hands it's usually around 15%, which is significantly higher than single embryo transfer. In conclusion, from the mother and child safety perspective, for the reason of medical efficacy and cost effectiveness, we have reasons to believe you should go straight to IVF. We're going to be doing these debates more often from Australia. This is a great panel. One side, please. Unexplained infertility. My colleagues were comparing IUI ovulation induction with IVF, but there are other ways of achieving pregnancies with unexplained fertility. I'm going to take the patient's perspective a little bit here. It's all about shared decision-making, so the patient needs to be involved in the decision-making. And it's quite clear from all the data that many patients with unexplained infertility will fall pregnant naturally by themselves even if you do nothing. So sometimes there's definitely a place in doing nothing, and the patient needs to be aware of that. So it's all about informed consent. How do we inform the patient? So we've got to make a proper diagnosis, as my colleague Dr. Boothright has already mentioned, and just to jump into IVF because it's cost-effective is not doing our patients a justice. The prognosis is really, really important, and even after 20 years of doing this, it's all about the duration of infertility, the age of the patient, and discussing that prognosis with the patient. We all know that patients who have been trying for longer and who are older do have a worse prognosis, and maybe they do need to look at treatment quicker, but there are many patients that we see that have a good prognosis, and just explaining that to them is all they need to achieve a pregnancy naturally. And then we're going to talk about other options. It's wrong not to offer those to patients, and my colleague Dr. Quick will talk about that in a moment. Look, we've all had patients that have been scarred by IVF who've spent a lot of money on IVF, did not fall pregnant, and I think the fact that they weren't informed properly, that the diagnosis wasn't made properly, is very frustrating to them. So to just jump into IVF again is not doing the patients a justice. And look, there are negatives to IVF. There's not just the cost to the patient, the cost to society. As taxpayers, we all pay for IVF. It's funded here, or sponsored to some degree, and it's also the family and everyone else that's involved in paying for this. So this is not a treatment that is without cost. There are some harms. We know that ovarian hyperstimulation syndrome still exists, even though it's much less than it used to be. There's a risk of infection and bleeding from the procedures. And we can look at the baby. The data still suggests that babies born from IVF are smaller and they're born earlier, and monozygotic twinning is more common with IVF, so these are high-risk pregnancies, and all this may have an impact on the long-term health of the babies somewhere down the track at the moment. That is important to still look out for. But I come back to the emotional toll. Our colleagues were saying that finishing infertility quicker helps to kind of reduce the emotional toll, but the procedure itself does have its own toll if it doesn't work, and so we've got to prepare patients, have them informed. But at the end of the day, it's all about patient choice. How can a patient make a choice if we don't make a proper diagnosis, give them a prognosis and offer them some other choices that exist? And running the anchor leg of the race for the pro side. IVF in couples with unexplained infertility is the best tool we have in our reproductive medicine toolkit for multiple reasons. Professor Hart has clarified the definition of unexplained infertility. As a reflection of the degree of investigation we've undertaken. He's explained that IVF is often importantly diagnostic as well as therapeutic, both demonstrating and overcoming barriers to natural conception. Dr Stankiewicz has convinced us that IVF is efficient, safe and cost-effective. My goal is to show you that IVF is the correct therapy to meet the immediate and big picture family planning goals for our patients with unexplained infertility. More than 80% of couples with defined unexplained infertility who attempt IVF treatment will have a baby. In Australia, ANZSREI data shows us that the average age of the female patients who present with primary unexplained infertility is over 35 years. And in fact the average is 38 years. We're all aware that the average age of first maternity in Australia has progressively become later over the past two decades. Currently it stands in the mothers and babies report at 32 years. If the average age of first maternity is 32 years, this means that at least 50% of women attempting their first pregnancy are over 32 years. Research I conducted in Melbourne University with my student Eugenie Pryor asking university students of their family planning intentions and aspirations demonstrated that most people, male and female, want to be parents and most want to have more than one child. However, in Australia, our most recent survey shows that births are at an all-time low, below replacement rate and falling, with an ever greater proportion of our population being unable to have the number of children they aspire to and an ever growing proportion seeking assisted reproductive care. Fertility declines with age. Factors include egg quality concerns, sperm quality concerns and the accumulation of pathologies over time. Adenomyosis, fibroids, endometriosis are concerns that no person is born with. They exist on a spectrum and progress over time and may be contributing factors for unexplained infertility. Our patients, when we meet them, are the best IVF candidates that they will ever be. They are the youngest they will ever be and they have the best ovarian reserve they will ever have. They will generate more euploid embryos now than they will in years to come. The sooner we get our patients pregnant, the sooner they will give birth. It takes nine months to have a baby, 12 months potentially to breastfeed and wean and of course most patients will need time to care for a young infant and recover prior to attempting another pregnancy. IVF and embryo banking may represent not only their best chance of conception with reduced time to pregnancy but also an opportunity for embryo banking to improve their cumulative live birth rate potential over time. By the time our 38-year-old patient returns to try to conceive for a second child, she will undoubtedly be aged over 40. Her chance of live birth per cycle initiated at IVF at this stage has reduced phenomenally. The ANZSREI dataset from our most recent report quotes that statistic to be 5%. Her chance of conception with an embryo frozen at 38 years, conversely, is one in three to one in four. There is no room for doubt that IVF gives couples with unexplained infertility not only the most effective treatment we have to help them have a baby, but their best opportunity to have a family. Last but certainly not least, Dr. Quick, to round out the con sides arguments before we open up for rebuttal. And I'll make a small plea that if you have questions that you'd like to pose directly to the panel, prepare them and we'll make sure we get to them from the audience shortly. Thank you. So, whilst we have heard that we may be bad doctors because we're delaying our patients' time to pregnancy, I would perhaps put it to you that unexplained infertility is a diagnosis which is made based on exclusion. So perhaps you are the bad doctors because you haven't looked hard enough for the cause of the unexplained infertility. So, in terms of the tests that we all would do, I think, we would all ensure that the woman has an ovarian reserve. We would all ensure that she has no structural anomaly inside the uterus. We would all ensure that her tubes are patent. We would all ensure that she has regular cycles. We would ensure that he has a normal semen analysis. I think these are tests that we would all do when trying to evaluate a couple for fertility who are struggling to conceive. And therefore, the chance of them getting pregnant naturally, it's never going to be zero. And one option therefore, instead of running straight to IVF, would be to say, OK, continue timed intercourse because the chance of you conceiving naturally is not actually zero and this would be the most natural way to conceive, the cheapest way to conceive, the least interventional way to conceive. And whether that be with cycle tracking to ensure appropriate timed intercourse, whether that be with cycle tracking to ensure adequate luteal phase support. When you clear the fallopian tubes, we know that there are studies showing an improvement in natural conception. Lipidol or oil-based tubal flushing techniques may also help couples to conceive naturally. And then you don't have this multiple pregnancy rate that IVF has. You don't have the cost that you incur with IVF, not just for the couple but to Australian society because IVF is subsidised in this country. You don't have the risks that the woman goes through to undergo IVF treatment. You don't have the risks that the baby takes on being conceived via IVF. And so conceiving naturally, because it's not going to be zero, is definitely an option for these couples. In terms of further tests or further investigations that you could do, some people would argue, yes, we haven't looked hard enough for the reason for infertility, therefore we know that ultrasound is notoriously bad at picking up superficial endometriosis. We know that ultrasound cannot pick up subtle changes in the endometrium, as Dr Boothroyd referred to chronic endometritis, for example. So these patients perhaps should undergo a hysteroscopy to see if there is an endometrial issue. Perhaps these patients should undergo a laparoscopy to see if there is superficial endometriosis. And there are meta-analyses showing that resecting or treating superficial endometriosis may actually help these couples conceive naturally down the track and then therefore they avoid having more interventional treatment in order to conceive. There is also intrauterine insemination with or without ovarian stimulation, which may improve their chances of conceiving naturally. And that again would be less invasive, less intervention and cheaper for the patient. And we know that therefore there are a lot of other treatment options available to help these couples to conceive. And if it's less invasive, it's more natural, it's cheaper, that ends up being better for the patient. Psychologically as well, which the other side have brought up, even with Dr Stankiewicz's 38% ongoing pregnancy rate, that also means that 62% of his patients are not going to be pregnant. The psychological impact of that cannot be underestimated because for a lot of patients, IVF is your last resort. And when you don't get pregnant with IVF, that creates an issue too for them. Embryo banking, which was also brought up, what happens when you create surplus embryos and what's the psychological impact of having to deal with embryos that you are then not going to use in the future? So therefore for those reasons we feel that IVF is not your first line treatment for couples who are diagnosed with unexplained infertility. There are many other ways to help these couples to conceive. We just have a multitude of things to unpack. And I want to start off by opening up an opportunity for rebuttal. I saw both sides of the panel here taking diligent notes. I think all of us have a full page worth of things that kind of stood out to us. Since the pro side had an opportunity to begin, I'm actually going to start with the con side and allow the con side to answer specific points made by the pro side and provide just a little bit more detail and clarity for why they think IVF is not the way forward. My learned first speaker, wearing his tie of course, indicated that it was all about laparoscopy and IUI, and it's way more than that. I just want to highlight to you the paper by Dressler in 2017 in the New England Journal of Medicine, a randomised controlled trial of what would be unexplained infertility according to the definition I put out, the less than 35 ovulatory normal semen analysis. And the intervention was an HSG with either oil-based contrast or water-based contrast. And over the six months, there was clear separation, and this is an effective treatment for unexplained infertility or mild or minimal endometriosis, however it might work. And there's probably separation out to three years. So as a single intervention, as an alternative to IVF, the use of oil-based contrast is an option. So it's not just about laparoscopy and IUI. I guess the other thing the second speaker did allude to, fairly abysmal success rates with IUI being 6%. That is a problem, and I would like to allude to a very good pragmatic trial conducted by Cindy Farquhar and Emily Lu and their co-workers in New Zealand that really swung the meta-analysis for the use of clomiphene and IUI to clinical efficacy. And they reported a 33% chance of live birth in their IUI and clomiphene arm. I'm going across to Auckland to see what the magic is in that city. What are they doing? The third speaker did allude to the problem of declining fertility, a global problem, and Australia is not alone. We have solved the problem to date, which we've had for 40 years, with immigration. But Georgina Chambers' work shows beautifully that IVF is not the answer to the falling fertility rates. It is a way more complex social problem and is probably outside the scope of today's discussion. So those are my three rebuttals to our wonderful team. Thank you very much. So... You can't bury them. We'll give them an opportunity. Thank you for the opportunity. So I'd like to address some of the points that my learned debaters on the opposition raised. The first speaker really suggested quite a few things that we probably omitted, like endometritis, failing to examine the male. I think things like that... I think, at a good history, that is essential what we do as part of our investigation. We're looking for a history of cesarean section, complications subsequent to that. We're doing a detailed scan, and that will exclude the fact that she's got a poor endometrium development, she's got a cesarean scar niche. A good history of a male will allude to the fact that he has some metabolic disorder, degree of hypogonadism. So we're not delaying anything by these appropriate investigations. Adenomyosis will be raised. I talked about a detailed gynaecological examination. So I honestly think that a very... As my opening line was, a detailed gynaecological scan, obviously with a very good history taken, is essential. We're not delaying her opportunity to go straight to IVF if we've addressed all these factors. The second speaker talked about shared decision-making, and we'd all completely agree with that. But we have to be honest and open about the success, which my second speaker talked about, the success of the treatment we're offering. And one thing we should sort of dwell on is it's all... It's a fundamental description of the success of treatment is probably all about prognostic models, and that who not model, that's the original model about the success of conception, is really... Everything flows on from that, which basically talks about a good prognosis patient. 30% chance of live birth after a year. That's what they talk about, a good prognosis patient. Perhaps the rest of the world is different to your average Australian patient, but if we talked about that being a good prognosis, you've got a one in three chance of being pregnant by a year. I think most of our patients would throttle us. So that is what all the models are sort of based on, that being a good prognosis patient. So I completely agree with the second speaker that we do have a shared decision. We have to be honest with our patients about the success. We have to be honest about giving them the prognosis of any treatment that we offer. But really, as my third speaker was talking about, it's about giving the patient the opportunity to have a family, minimal career disruption, minimal life disruption. We have to be honest and talk about the whole picture. They're focused on the first child because really they can't think beyond that. We're talking about giving them the family that they need. The third speaker spoke very eloquently about the risks associated with the treatment we offer. I believe we offer a very safe service with our IVF, particularly in Australia, with our 2% twin pregnancy rate. We talk about the higher risk of these pregnancies, but they perhaps don't relate to the treatment we're offering. Perhaps, unfortunately, is the patient, if she's got polycystic ovary syndrome, if she's more likely to have diabetes, premature delivery, preeclampsia. So I think often the risks associated with IVF and potentially the risks associated to the child born from IVF perhaps don't relate to the treatment of IVF per se. It may well be the woman and perhaps her partner, their underlying medical condition, which lead those risks. So I strongly would encourage you to believe that you take a very good history from your patient, you do a thorough investigation, as I've alluded to, looking for any signs of ovulatory disorder, any gynaecological disorder by a detailed scan, checking tubal patency and a detailed history and the similarities from the man, and then you'll find you're probably going straight to IVF. APPLAUSE I'd like to talk a bit about the embryo banking and having been in this field for a long time, as a word of caution, we're setting a lot of expectations. I remember going to an ASRM meeting probably 10 years ago where they had this headline, all your embryos in the freezer, your whole family in the freezer, basically expecting that if you get four or five embryos frozen that you'll end up with a family at the end. We all know that for the patient, they're not a percentage, it's either zero or 100%. And if all the embryos don't work, they don't have a family at the end, you know, it didn't work for them and their expectations haven't been met. And the way we talk about the percentages and that we can solve the patient's problems, that we can make families, it doesn't always happen. So the expectations our position is setting here, we're not always able to meet and so we're going to end up with very unhappy patients. So this is just a warning to everyone that we need to tell people that this doesn't always work and sometimes they'll end up with no success at all. And from that point of view, I think the way it's presented is way too simplistic and we've got to go back to looking at the other options and not promising things we can't always deliver. So just taking into account all our esteemed interlocutors have said, we don't necessarily disagree with the amount of investigations that they described because nowhere in our argument we said that as soon as the patient registers with the receptionist, they will direct it to an IVF lab. I think to imply so, we'd be very rich indeed. Maybe there are some clinics that are so efficient. I don't know how it works overseas, but certainly not in Australia. The other point that was made about the cost of IVF and our, again, esteemed interlocutors are very well aware from the studies done here in Australia that actually every baby that we have to conceive through IVF and create and lives is actually more than 10 to 100 times return on investment because we are creating future taxpayers. We are creating people that will repay the IVF treatment costs over and over and over again. So I'll put to you, Rob, that if you are saying that we can't do IVF because it costs money, you are robbing future treasurers of a huge amount of dollars. I hope the American audience is listening. In America, we call embryos unborn children in freezers in certain parts and here they're unborn taxpayers. Con side, final opportunity for rebuttal before some audience questions and one more word from the pro side. Well, actually, Dr Stankiewicz was very happy to hear that you're not going to send your patients straight to the IVF lab because we've managed to convince you that that's not the right thing to do. I clearly have forgotten how to debate because I did all my rebuttals at the end of my presentation but essentially I'll recap because when we're talking about IVF, as we're saying, the chance of pregnancy is not going to be 100% and so there is a psychological impact to IVF not working. There is a psychological impact to banking embryos and creating surplus embryos that eventually may not be used and they were my main rebuttal points in terms of why IVF was not the first-line treatment. Thank you. So we've heard from the opposition some very valid points of how our patients can be psychologically impacted when fertility treatment is unsuccessful. I will again remind you that IVF is the most successful fertility treatment we have in our treatment armoury. We are most likely to help our patients have a baby with IVF. The cumulative pregnancy rates for IVF have started back in the late 70s and early 80s in single-digit percentages. We now, with a best prognosis candidate, have at least a one-in-two chance of that patient having a baby per embryo transfer and in our patients with unexplained infertility, the vast majority of our patients will have success. We also heard from the negative team about the significant chance of pregnancy in patients with expectant management. You're right, there's not a 0% chance of natural conception in patients who have unexplained infertility, but there is a not very good chance. We know from data that we've had for a really long time, going back as far as the Hutterite data, to today's non-contradictory models, which tell us that a couple's chance of conception per month in best prognosis candidates is one in five. If they've been trying for six months, it's one in ten. If they've been trying for 12 months, it's only 5%, and if they've been trying for 24 months, it's less than 1%. So it may not be zero, but it isn't very good. In terms of our team reminding us of the extended ICMART definition of unexplained infertility, we don't argue. When we say someone has unexplained infertility, we make the assumption that they have been comprehensively diagnosed by a robust reproductive endocrinologist, as everyone in this room is. And I would say one closing rebuttal. IUI success rates have been the same for the last 50 years, whereas IVF success rates continue to improve. Why would you offer your patient a treatment from 50 years ago when you can offer them one from today? Thank you. APPLAUSE I'm going to take a personal privilege and ask the first question, in hoping that the microphone makes its way to the second question in the audience. My colleagues on the pro side have said IVF, IVF, IVF. Can you be a little bit more specific about what kind of IVF? Do you mean IVF with ICSI? Do you mean IVF, ICSI, and PGT? Be a little bit more deliberate for us and tell us exactly how the patient with unexplained infertility should receive IVF. As I said in my statement, I think it's a diagnostic evaluation. I think there is an argument to consider ICSI, but I think ICSI does have some negative consequences for children born. I think perhaps going straight to ICSI is too much. I think going straight to PGTA perhaps is too much, unless there is something in their history which should indicate that. But we're talking about unexplained infertility. So I believe a standard IVF cycle, looking at the opportunity to assess embryonic development, is the way to go. I do not think you should be going straight to ICSI. I think the principle of first do no harm is probably a safe approach. I don't know whether my colleagues have some other comments, but I think that would be the first approach rather than going all guns blazing. I can understand, though, in different settings in the world, there may have... We're very fortunate in Australia, we're very well supported from the government support for IVF, but I think the imperatives in different countries may be different. But I think that approach would be the right one first. We'll start with a question from the audience. And if you could introduce yourself and have the question allowed for our members in the audience who are not here. It's Louise Hull here from Adelaide. The question I would like to put to both the pro and con team is that Geeta Mishra from the University of Queensland showed that if you had diagnosed endometriosis before IVF, you were more likely to have a pregnancy and much less likely to have high-order IVF cycles. Given that we now have really good non-invasive diagnostics, we're actually... A lot of the time we can pick up superficial or stage 2 endometriosis if you get the right scan. We're going to do IVF better if we know about it. Can you comment on that impacting even the diagnosis of unexplained infertility? Thanks. I'd love to take that. Can I go first, Roger? LAUGHTER Please do. Look, I'd love to take that question. It's a really good question. And, of course, this is not unexplained infertility, so this is outside the scope here. And I think, really, what we're seeing now, in contrast to where we were at the time of the Markku study, which was all... And the Tulandy study on endometrioma excision, we now see that that is actually damaging to fertility, particularly where there is ovarian endometriosis, and that we compromise their ovarian reserve by doing this surgery before we preserve their fertility, be it oocyte cryopreservation or embryo cryopreservation. So I think it's a bit outside the scope of this talk, but I think the swing of the data now is that we should be doing fertility preservation before we do surgery for deeply infiltrated ovarian endometriosis. And that would fit with Gita's findings. A brief response. Thanks very much, Louise. Yeah, we're talking about unexplained infertility here, and my opening line was we need a history, but a detailed gynaecological ultrasound. I think it's important it's a really good ultrasound to exclude that, because the evidence around very minor endometriosis is not there. I agree with significant endometriosis, but that's not the subject of this discussion. But I do believe with very minimal endometriosis there is really no evidence for that. Janelle MacDonald from Sydney. I'm going to play devil's advocate here. So everyone is probably aware of the recent government inquiry about obstetric violence. I'm a little concerned that if we are perceived to be encouraging women to IVF first, are we guilty as a profession of performing fertility violence? That's just digressing a little bit, just thinking about how the consumers may perceive this. I think our patients want to have a baby, and that's why they come to see us, and that's what we help them to do through IVF. I'm not sure the microphone's working. And just introduce yourself. I'm from Sydney, Australia. Can I disagree with you, Roger, about that question about minimal and mild endometriosis? I'm 68, so I'm old enough to have read a whole lot of papers in the past that are probably seen as relics. But Mark Khoo published an unusual study, because it was actually an RCT. Well, sorry, not an RCT. It was a study whereby... Well, it was an RCT, and it was randomised really well. It was done in Canada, and there were about 350 subjects, and they were identified to have stage 1 or stage 2 endometriosis at laparoscopy. And the interesting thing is it was seen as an intervention which didn't greatly increase the chance of conception, but it doubled the monthly chance of conception. So there was clearly a difference between those patients who didn't have endometriosis and those that had stage 1 and stage 2 endometriosis. So the intervention did actually result in an improvement. One of the quotes was, well, I heard since then, well, it didn't make much difference. But when you realise that infertility is multifactorial, there were probably other factors involved as well. So any increase like that in stage 1 and stage 2 endometriosis sufferers was clearly beneficial for them. So I wouldn't disagree with you completely, but I do think you've got to take it on board that there is some evidence that surgical intervention can help. And certainly in those patients whereby the financial costs of IVF are still quite, even in Australia, astronomical. Many patients can get this through the public sector or the private sector treatment of their endometriosis laparoscopically very cheaply or at no cost. Thanks, Dr Persson. So you're right that there was also a counter-randomised controlled trial by the Grupo Italiano which was a counter to that. And actually did not show any benefit. But I believe the Marcu study demonstrated an excess of conception and with treatment of minima and endometriosis of about 4% per month for a few months. So absolutely, that shared decision-making. Personally, I wouldn't like a laparoscopy to give me an extra 4% chance of a natural conception for four months, which I think the data was. So basically, the basis to my statement that I said without going into great detail was a review article published by Samy Glarner recently in Reproductive Biology and Endocrinology. And their conclusions were what I basically said, that from looking at all the data, there is no real evidence of intervention for minor endometriosis. We're not talking about pain or significant diagnosed endometriosis on the outcomes of IVF, ovarian reserve, egg quality, embryo development, and euploidy rate. So that was the basis of my... I hate to disagree... I hate to agree with my opponents in a debate, but I'm going to... But there is actually a new network analysis by Rui Wang and some serious heavyweights in evidence-based medicine that pulls together the surgical studies. And the thing that made the most difference to this of mild and minimal endometriosis from a fertility point of view, not pain, is the use of oil-based uterine contrast. And I commend that paper to you, which fits with exactly what Roger is saying. Hi, my name's Lucy Prentice.  I work in Auckland. And I just wanted to point out the New Zealand perspective a little bit. Where we come from a country with very limited public funding for IVF. I'm currently running an RCT with Cindy Farquad directly looking at IVF versus IUI for unexplained infertility. And I'd just like to point out that both the ASRM and ESHRE guidelines, which are the most recent ones, both suggest that IUI should be a first-line treatment with oral ovarian stimulation. We have no evidence that IVF is superior based on an IPD meta-analysis published very recently and also a Cochrane review. And although we would love to be able to complete the family that our patients want from IVF and embryo banking, that option is really not available to a lot of people in New Zealand because of prohibitive costs. We know that IUI with ovarian stimulation is a very effective treatment for people with poor prognosis and unexplained infertility. And I also would just like to add that there's not a cost-effectiveness analysis that shows an improvement in cost-effectiveness for IVF. There's also never been a study looking at treatment tolerability between the two, so I don't think that you can say that IVF is a treatment that people prefer over IUI. So I may turn around and shoot myself in the foot based on our results that will be coming out next year, but I think at the moment I don't think you can say that IVF is better than IUI with ovarian stimulation for unexplained. We have time for two more questions from the audience, and we have two hands in the back. Now we can. It's the light green. OK. Hossam Zini from Melbourne. Thank you very much for the debate. It's very interesting. The problem is that all of the studies that have been done about comparing IUI to IVF, they are not head-to-head studies. The designs are different. They are having, like, algorithmic approach. For example, they compare three or four or five cycles of IUI to one cycle of IVF. But about 10 years ago, our group at the Royal Women's Hospital, we have done a study, a randomized control study, to compare IUI to IVF head-to-head, and we randomized the patients at the time of the trigger who only developed, so we did a low stimulation to get two to three follicles only, and that's why it was so hard to recruit lots of patients. So the criticism that was given to the study that it's a small sample size, but we end up with having IVF as a cost-effective treatment. Our IVF group had a live birth rate about 38%, and on the IUI, 12%. And with our cost calculations, we find out that the IVF is much more cost-effective than the IUI. But I believe that we all now believe in individualized kind of treatment, so patients probably who are younger than 34 years old probably wouldn't go straight to IVF. Maybe I'll do a laparoscopy and a histroscopy first, okay, and we may give them a chance to achieve a natural conception in the next three months or so. Patients who are older than 35, 37 years old probably will benefit straight from IVF. But again, in day-to-day life cases, we will not force the patient to go straight to IVF. I will talk to her and I'll tell her, these are your options, expectant treatment. This is the percentage that you would expect. IUI, this is what you expect. IUI with ovulation induction, this is what you expect. IVF, this is what you expect. And then she will discuss that with her partner and come back to me and tell me what she wants to do. Thanks. I saw a hand show up right next to you, so I'll add one more question given our time limitation. Thanks so much, Kate Stone-Mellon. I'd like to ask our panel to take themselves out of their role playing and put themselves in another role where they were the head of a very, very well-funded public service, and I'd like to ask the two sides what they really think about what they would do with a patient at the age of 35 with 12 months of unexplained infertility. Well, can I say that? Because that's my role in a different hat. LAUGHTER So, yeah, I run the state facility service in Western Australia. We looked at the data, because obviously that's what we're doing, IUI, IVF, and unfortunately we stopped doing IUI treatment. The success rate was so low. So we do go straight to IVF with unexplained infertility. Disappointing, as I'm sure you hear that, Kate, that we do. We looked at the data. Yeah, I think that I would still offer the patients the options, because some people don't want to do IVF. Even though it's completely free, they may not still want to do the injections and the procedure and take on the risks of the actual egg collection procedure. I don't know, religious issues with creating embryos. Yeah, I would still give patients the option. We have time for one more question in the back. We'll take the other ones offline afterwards. We'll get you a microphone just to make sure our listeners afterwards can listen. Following on from the New Zealand experience, which I've experienced... Hello? Yeah. From the New Zealand experience, and having worked here extensively and in New Zealand, you're not comparing apples with apples, Claire. That unexplained couple in New Zealand will wait five years to get funding and currently perhaps another two years to get any treatment. That's then an apples group compared to the pilot group who may, in fact, walk past the hospital and get treatment. The other thing about this, I think, that we need to forget, or don't forget, is the ethics of things here, two of which is that the whole understanding of unexplained infertility needs research and thinking. And if it wasn't for that understanding of what is the natural history of normal and then the understanding of pathology, we wouldn't do a lot of things in medicine. So if we have got a subgroup here that's unexplained, it's not just to the patient, we have a responsibility to future patients and ourselves to be honest and do research and learn about these factors. Now, it doesn't answer the debate, but it is something that's what drives the investigation and management of unexplained delay. And, for example, at the moment, there's quite a discussion about two issues of ethics, one about the involuntary childlessness of people that don't get to see us but don't have those children that they wanted to have because they didn't want to undergo treatment, or it was the involuntary childlessness of a second or subsequent child. And that's quite a big research issue in Europe, I realise, at the moment. And the final thing is about the information giving. The British case Montgomery 2015 has changed consent substantially, for those of you from England, that all information given to patients must include and document the discussion about expectant management versus all the different types of treatment, for and against and risks. And we're not currently doing that in IVF in this area, but if you read about what's happened in England, it's transformed consent in surgery. And I think a lot of our decision-making isn't in that way. So there are a couple of ethical principles to think about. Wonderful questions from the audience. Since we're coming up at the end of our time, we typically end the debate with closing remarks, but we'll forego that for this debate. And I'd actually like to just poll the audience. After hearing both the pro and the con side's arguments, by a show of hands, who in the audience believes that for the patient with unexplained infertility, as defined and detailed here broadly, should we be beginning with IVF? Should we be going straight to IVF? So by a show of hands. And I would say probably 50% of the room raised their hand. And those who think we should not be going straight to IVF? It feels like a little bit more. 40-60, now that I saw the other hands. Well, I'm going to call this a hung jury. I don't know that we have a definitive answer. Please join me in a round of applause for our panelists. In America, we would call that election interference. I wanted to thank our panelists, our live audience, and the listeners of the podcast. On behalf of Fertility and Sterility, thank you for the invitation to be here at your meeting and hosting this debate live from the Australian New Zealand Society for Reproductive Endocrinology meeting in Sydney, Australia. Thank you. This concludes our episode of Fertility and Sterility On Air, brought to you by the Fertility and Sterility family of journals in conjunction with the American Society for Reproductive Medicine. This podcast was developed by Fertility and Sterility and the American Society for Reproductive Medicine as an educational resource and service to its members and other practicing clinicians. While the podcast reflects the views of the authors and the hosts, it is not intended to be the only approved standard of living or to direct an exclusive course of treatment. The opinions expressed are those of the discussants and do not reflect Fertility and Sterility or the American Society for Reproductive Medicine.    

¡Buenos días! 🇻🇪Hoy se cumplen cinco días días sin que el Consejo Nacional Electoral de Venezuela muestre las actas de la votación, pese a la presión de varios países y que han estallado protestas en todo el país. Gabriel Vegas nos cuenta más detalles MIENTRAS...El Congreso que dice condenar la dictadura en Venezuela, ahora quiere APROBAR darle pensión vitalicia al exdictador peruano Alberto Fujimori. ADEMÁS: Alonso Correa nos hace soñar con traer una medalla olímpica al Perú. ¿Recibió apoyo del IPD? Y... Hoy es el último día de Romina Badoino siendo productora de La Encerrona. Ella les cuenta un poco de lo que han sido estos cuatro años detrás del programa. ¿A dónde se va? **** ¿Te gustó este episodio? ¿Buscas las fuentes de los datos mencionados hoy? SUSCRÍBETE en / ocram para acceder a nuestros GRUPOS EXCLUSIVOS de Telegram y WhatsApp. También puedes hacerte MIEMBRO de nuestro canal de YouTube aquí / @marcosifuentes **** Únete a nuestro CANAL de WhatsApp aquí https://whatsapp.com/channel/0029VaAg... **** Para más información legal: http://laencerrona.pe

In this episode, Nick Carman is joined by Derek Williams, Managing Director for Investor Relations at the Valesco Group. Derek shares his journey from his early days in research to his senior roles in investment management with companies like Landsec, Global Student Accommodation, and Rothschild, leading up to his current position at Valesco Group. The conversation covers his career milestones, the challenges he faced, his leadership philosophy, and his continuous quest for learning and growth.Come and join our LinkedIn community: https://www.linkedin.com/groups/9054319/Leave a review on the platform of choice if you've enjoyed this episodeKey Points:Introduction to Derek Williams (00:00:00)Nick introduces Derek Williams and provides an overview of his career.Early Career and Interest in Real Estate (00:00:32)Derek discusses his initial interest in the real estate market during his school days in the 1980s.Learning from Mentors (00:03:16)Derek reflects on the values and professionalism he learned from his early mentors.Transition to Investment Management (00:04:16)Derek explains his move to investment management and his decision to pursue a master's degree at Cass Business School.Joining IPD and Early Management Experience (00:06:42)Derek discusses his role at IPD, managing a team, and the challenges he faced in his early management days.Role at Land Securities (00:09:13)Derek talks about his transition to Land Securities, working with Francis Solway, and the lessons he learned during this period.Expanding Horizons to Global Markets (00:14:00)Derek shares his desire to globalize his experience and his subsequent move to Russell Investments.Experiences at Russell Investments (00:16:00)Derek discusses launching global REIT products, his mentors, and his leadership experiences in the US.Entrepreneurial Ventures (00:21:00)Derek talks about reconnecting with his entrepreneurial spirit and his roles at B Finance and Global Student Accommodation.Current Role at Valesco Group (00:28:27)Derek describes his current role at Valesco Group, the company's unique approach, and his focus on growth and team spirit.Personal Reflections on Success (00:30:11)Derek shares his thoughts on success, the importance of learning, and maintaining personal relationships in his career.Conclusion: Derek Williams shares valuable insights into his career journey, highlighting the importance of continuous learning, mentorship, and taking calculated risks. His experiences offer a blueprint for aspiring real estate professionals looking to accelerate their careers.Sponsor: This podcast is brought to you by MacDonald and Company, the global real estate recruiter. Don't forget to click follow and leave a rating to ensure you never miss an episode. Hosted on Acast. See acast.com/privacy for more information.

Visit nascentmc.com for the full writup of this episode and medical writing assistance.  Visit learnamastyle.com for free downloads directed towards medical writing and editing. • The FDA has approved the 21-valent pneumococcal conjugate vaccine, CAPVAXIVE™ (Merck), for the prevention of invasive disease and pneumonia in adults aged 18 years and older caused by 21 Streptococcus pneumoniae serotypes. Capvaxive includes eight serotypes not covered by other pneumococcal vaccines, addressing approximately 27% of IPD cases in adults aged 50 and older, and 30% in adults aged 65 and older, based on CDC data from 2018-2021. The approval follows an FDA Priority Review and is based on immune responses measured in the Phase 3 STRIDE-3 trial, with continued approval contingent upon verification of clinical benefit in a confirmatory trial.  • The FDA has approved delandistrogene moxeparvovec-rokl (Elevidys) for Duchenne muscular dystrophy (DMD) in ambulatory individuals aged 4 and older with a confirmed mutation in the DMD gene, as well as granting accelerated approval for non-ambulatory individuals. Elevidys, a one-time intravenous gene therapy, delivers a working copy of the DMD gene to address the muscle degeneration caused by mutations in this gene. The approvals are based on findings from a confirmatory trial that, while not meeting its primary endpoint, showed success in several secondary measures, with the Phase 3 ENVISION study underway to serve as a postmarketing requirement. • The FDA has approved adagrasib (Krazati) plus cetuximab for adults with KRAS G12C-mutated locally advanced or metastatic colorectal cancer (CRC) who have received prior treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy. Adagrasib targets the KRAS G12C mutation, a common driver mutation in several cancers including colorectal cancer, while cetuximab enhances its antitumor activity. The approval was based on findings from the KRYSTAL-1 trial, which demonstrated a confirmed overall response rate (ORR) of 34% and a median duration of response (DOR) of 5.8 months. • The FDA has approved pembrolizumab (Keytruda) in combination with carboplatin and paclitaxel, followed by pembrolizumab monotherapy, to treat primary advanced or recurrent endometrial carcinoma in adults, marking the third endometrial carcinoma indication for Keytruda in the US. Keytruda enhances the body's immune response against tumor cells by blocking the interaction between PD-1 and its ligands, PD-L1 and PD-L2. The approval is based on results from the phase 3 KEYNOTE-868 clinical trial, which demonstrated significant improvements in progression-free survival for patients treated with Keytruda plus chemotherapy compared to those receiving a placebo with chemotherapy.  • The FDA has approved risankizumab-rzaa (Skyrizi) for the treatment of moderately to severely active ulcerative colitis in adults, making it the first specific anti–interleukin 23 monoclonal antibody indicated for both ulcerative colitis and moderate to severe Crohn's disease. Risankizumab-rzaa inhibits interleukin-23 (IL-23), a cytokine involved in inflammatory and immune responses, thereby reducing inflammation. The approval is based on data from two phase 3 clinical trials, INSPIRE and COMMAND, which demonstrated the achievement of clinical remission and endoscopic improvement. • A supplemental Biologics License Application (sBLA) has been submitted for guselkumab (Tremfya) for the treatment of adults with moderately to severely active Crohn's disease. Guselkumab, a fully-human, dual-acting monoclonal antibody that blocks IL-23 and binds to CD64, was previously approved for moderate-to-severe plaque psoriasis and active psoriatic arthritis. Support for the BLA is based on findings from the Phase 3 GALAXI and GRAVITI clinical trials.

In this episode, I interview Tammy Pilton-Pluck, an accomplished nurse with over 20 years of diverse international nursing experience. Tammy shares her journey from an unexpected start in nursing to founding Intrepid Professional Development, where she empowers nurses globally. They delve into career resilience, personal growth, and the importance of clinical supervision and supportive environments in nursing.Key Moments:00:00:02 - IntroductionLiam welcomes Tammy Pilton-Pluck to the podcast, highlighting her extensive nursing background.00:00:54 - Behind the ScenesDiscussing the support Tammy provides to nurses and the importance of behind-the-scenes conversations.00:01:08 - Tammy's Diverse Nursing BackgroundTammy's journey through various nursing specialties, from phlebotomy to palliative care.00:03:16 - Beginning in NursingTammy shares how a personal experience in her church community led her to nursing.00:05:56 - Career Challenges and Palliative CareTammy's move to palliative care and how it shaped her perspective on life and nursing.00:07:26 - 30 Seconds of CourageTammy explains her life motto of “30 seconds of courage” and how it has driven her career decisions.00:13:16 - Importance of Exit StrategiesDiscussing why every healthcare professional should have an exit strategy for continuous growth and avoiding burnout.00:20:22 - Appraisals and Self-ReflectionTammy emphasizes the need for self-appraisals and preparing for professional growth discussions.00:32:34 - Professional Nurse Advocacy (PNA)Introduction to PNA and its role in providing psychological safety and professional support for nurses.00:41:52 - Restorative Clinical SupervisionTammy discusses the importance of non-managerial, confidential supervision for nurses to discuss challenges and successes.00:57:03 - Launching Intrepid Professional DevelopmentTammy's motivation and journey in starting her business to support nurses' professional development.Listen to the full episode to gain insights into Tammy's remarkable nursing journey, the concept of 30 seconds of courage, and the essential strategies for building a resilient and fulfilling nursing career.For more episodes and resources, visit High Performance Nursing Podcast.Connect with Tammy here. Listen to the IPD podcast here!

This week, Dan and Laurie Dean are joined by Independence Police Chief Adam Dustman and Deputy Chief Michelle Sumstad as they discuss the loss of Officer Cody Allen, the Honor Flag, and the support the men and women of the IPD get from the community as they protect Independence. --- Send in a voice message: https://podcasters.spotify.com/pod/show/we-have-issues5/message

David Villa is the Founder and CEO of iPD Agency, a marketing and media firm that works with over 600 companies in several industries across the United States and Canada. David has over 20 years of national sales and executive management experience. Since the establishment of iPD Agency in 1995, David has been responsible for pioneering, growing, and scaling iPD into one of the nation's leading database management, business development, and digital marketing companies in the automotive industry and beyond. In addition to his sales and leadership experience, David is also a dedicated follower of Christ. He credits his success to those who he's been privileged enough to call his teammates, and to his savior Jesus Christ. https://davidvilla.me/ We discuss: TRANSITION & WHAT MOST PEOPLE STRUGGLE WITH DURING TRANSITION? HOW DO WE KNOW IT'S A DOOR GOD IS OPENING? ADVERSITY OR OPPOSITION DOESN'T NECESSARILY MEAN IT'S THE WRONG PATH | DISCUSS We discuss: FEAR & UNCERTAINTY & HOW WE BALANCE BEING INFORMED WHILE ALERT OF FEAR MONGERS? We discuss: MINDSET & OBEDIENCE DOES OUR LEVEL OF OBEDIENCE REFLECT OUR LEVEL OF EXPECTATION?FINE LINE BETWEEN OVER-INFLATED EXP AND COMPLACENTLY UNDERACHIEVING? PURCHASE OUR BOOK ON SPIRITUAL WARFARE: https://last-in-line-leadership.square.site/product/operation-333-the-little-black-book-on-strategic-spiritual-warfare/14?cs=true&cst=custom

We went down to Portland to visit some of our Avants friends and partners to the south! This week we finally got to chat with one of the smartest and nicest people we have interviewed to date, Chris Delano, President of IPD. Chris is as true of an enthusiast as it gets, who has always loved Volvos and upgrading them in every way. If you have a Volvo, you need to check out IPD! https://www.ipdusa.com/

We recorded a Quest 3 impressions segment, but audio from the background video played over our voices and made it unlistenable. In summary, the lenses are awesome with unmatched edge to edge clarity, the IPD setting is nearly unnecessary because of them, the horizontal FOV is pretty much the same as Index, there's a lot less glare/god rays than Index, Josh says it's like the Gear VR lens mod without the drawbacks, the built-in audio is good enough for Justin, it's comfortable with the BoboVR M3 Pro strap, the BoboVR B2 batteries are keeping it fully charged, Virtual Desktop wireless streaming is working very well, and Justin is going to stop using his Index in favor of the Quest 3. MR passthrough is cool, but it looks pretty low res and grainy, and there are distortions are warping, so it needs some work. Justin did a video on his channel demonstrating all of that. 0:00 Intro 2:41 The 7th Guest VR 19:57 Dungeons of Eternity 30:04 The Burst Demo 34:11 Widow's Walkabout DLC 37:38 Rooms of Realities 40:22 Does Justin want to F Alex & Josh? 45:20 IEYTD3 Co-op 50:58 Outer Wilds VR Mod 1:01:50 The Riese Project - Prologue 1:04:34 Gunheart 1:10:46 Crossfire Sierra Squad Update 1:11:43 Super Mario Wonder 1:15:56 Upcoming Games Lots of discussion about what we've been playing in VR. Justin's YouTube channel: https://www.youtube.com/mamefan Alex's YouTube channel: https://www.youtube.com/virtualinsider Nick's YouTube Channel: https://www.youtube.com/BuffaloPinball VR Gaming Podcast Discord link: https://discord.gg/Kbg44ADPD2 Justin's email: mamefanyt@gmail.com --- Support this podcast: https://podcasters.spotify.com/pod/show/vrgamingpodcast/support

Bodi obveščen/a, ko novembra izide AIDEA knjiga: https://aidea.si/newsletter-knjiga ============================= V epizodi 119 je bil moj gost Tomislav Kuljiš, priznan hrvaški terapevt in ustanovitelj IPD centra. Kot avtor programa Integralne telesne psihoterapije, se Tomislav trenutno intenzivno posveča prenosu svojega znanja in veščin na bodoče psihoterapevte preko izobraževanj in mentorstva. V epizodi se dotakneva naslednjih tematik: Zakaj je, tako kot je Izvor težav in osebna rast Travme Razvoj otroka in vedenje staršev Prisebnost in meditacija Vrste terapij Delovanje terapevta Nevzdržno stanje in samomor Vpliv izkušenj na delo terapevta Sodobna družba Hipersenzitivnost Digitalna zasvojenost Vprašanje prejšnjega gosta

Our host Gareth McGlynn, sat down with Mark Sands Founder of Building CATALYST, which applies a management philosophy that is grounded in systems thinking - which is inspired by the work of W. Edwards Deming, the father of quality and process improvement. Discussed in this episode of the Preconstruction Podcast: - Mark's journey from VP / Partner at The Christman Company to starting Building Catalyst in 2013 - The reasons behind starting Building Catalyst what was the mission at the time and how has that mission changed - What is Building CATALYST and why Owners and Contractors need it - The Psychology around change within our industry, what will it take for real change in our processes - How his customers reacted in 2019 when he integrated all the data from every customer - Building methods and how they can shape the change (IPD and Design & Build) - Wh0 uses Building Cataylst? And how it felt in 2022 hitting the milestone of 600 projects and over $10 Billion - The difference between the Silo approach and the System approach. And why we must adopt the system approach. - How structured data and a systems approach can all but automate the preconstruction process (example of the Mary Free Bed Rehabilitation Hospital) - And much much more - including the terrible Grand Rapids winters :-) As always our guests are incredible advocates for the Preconstruction space and are open to any follow up questions. The best place to get Mark is at the Building Catalyst website: https://www.buildingcatalyst.com/ Alternatively here is Mark's LinkedIn profile: https://www.linkedin.com/in/marksands/ As always folks please subscribe, share and comment across your preferred platforms. Stay in touch for more incredible episodes of The Preconstruction Podcast.

In this episode, we're talking about Spartan Invest's IPD. Our Investment Property Description outlines all the numbers needed to assess the purchase opportunity of our turnkey properties. Follow along with our IPD!Transcript--To learn more about our full-service turnkey operations, check us out online at www.spartaninvest.com.Connect with Spartan!Facebook: @spartaninvestInstagram: @spartaninvestTwitter: @spartaninvestConnect with Lindsay!Facebook: @spartanlindsaydavisInstagram: @spartanlindsaydavis

Aura Robinson, Manager of Enhanced Project Delivery at ISL Engineering (Canada) shares her experience with integrated project delivery (IPD) and emphasizes the importance of collaboration and valuing people in an IPD setting. She also provides tips for those considering implementing IPD, such as starting with a smaller project and finding the language of IPD and Lean Construction strategies that work for one's project and client. The conversation highlights the benefits of IPD, including decreased email volume, focus on building and experience, and increased value for all team members. This podcast interview can help construction professionals looking for insights on IPD and Lean Construction strategies for immediate use on their projects for higher collaboration and team performance.   Change-maker Aura Robinson is a Gold Seal certified Constructor with extensive experience in architecture, engineering, and project management. Aura finds new techniques and strategies to enhance project delivery in the design and construction industry. She has a passion for developing teams tailored to the industry's emerging trends, and has managed high-performing teams and projects to great success. Aura's search for a better way led her to Integrated Project Delivery (IPD). Her experience with IPD and dedication to improving the industry and helping owners realize their vision has led her to ISL Engineering. At ISL, collaborative approaches and Lean Construction strategies are at the core of their day-to-day operations, and Aura leverages her construction knowledge and unique perspective to help project owners and teams achieve their goals. Aura uses her experiences with IPD and Lean strategies to make project management easier, better, and faster.   Connect with Aura Robinson via LinkedIn at https://www.linkedin.com/in/aurarobinson/  Website at https://islengineering.com/  Email at arobinson@islengineering.com     Connect with Felipe via Social media and Free Lean and Scrum Training Resources at https://thefelipe.bio.link  RSM Podia Course Link: https://store.theebfcshow.com/rsm Subscribe on YouTube to never miss new videos here: https://rb.gy/q5vaht      --- Today's episode is sponsored by Bosch RefinemySite. It's a cloud-based construction platform. Bosch uses Lean principles to enable your entire team, from owners to trade contractors – to plan, communicate, document, and execute in real-time. It's the digital tool that supports the Last Planner System® process and puts it all together in one simple, collaborative ecosystem. Bosch RefinemySite empowers your team, builds trust, creates a culture of responsibility, and enhances communication. Learn more and Try for free at https://www.bosch-refinemysite.us/tryforfree     Today's episode is sponsored by the Lean Construction Institute (LCI). This non-profit organization operates as a catalyst to transform the industry through Lean project delivery using an operating system centered on a common language, fundamental principles, and basic practices. Learn more at https://www.leanconstruction.org  

Am I Consuming Too Much? Creation vs. Consumption and 5 Steps to Optimizing Your Personal Consumption! 2 Types of Information Consumption & Stef's Personal Consumption Breakdown Revealed   Type 1: Casual Personal Development (CPD) This type of personal development is best done ‘in addition to'! Finally, permission to multi-task! This personal development can be done while driving, doing laundry, or doing dishes. It is usually unplanned and doesn't take much 'brain space'. Examples are podcasts and audible books. Type 2: Intentional Personal Development (IPD) This type of personal development is intentional. It is planned into your work blocks. These usually take lots of focus and need your full attention. Examples of this include a course you are taking, meeting with a coach, dietitian, doing a mastermind, or bible study.   Here are some Simple Tips for More Production and Less Consumption as a Work From Home Mom Zero wasted tv time Zero social media scrolling Got rid of news No notifications   5 Steps to Optimizing Your Personal Consumption based on the 80/20 Rule. 80% production and creation and 20% IPD. This is based on Stef's example revealed inside today's episode! Inventory your CPD and IPD. What do you want this to look like? Schedule it in Live it out Revise I pray this episode blesses you! Enjoy. XO, Stef   All the things -> www.stefaniegass.com   Free Female Christian Entrepreneur Community-> www.stefgasscommunity.com Ready to get clear on your calling so you can start an online business? Join my Free, 4-Step Clarity Framework Workshop! Instant access at-> www.freeclarityworkshop.com Need a step-by-step blueprint on how to start your online business? Download a Free, 14-Step Biz Blueprint Checklist!-> www.completebusinessblueprint.com Wondering if you should start a podcast? Take this quiz and find out! -> www.startapodcastquiz.com   Wanna work together, friend!? Step 1: Get Clear on Your God-led Calling so You Can Start an Online Business-> www.clarifyyourcallingcourse.com Step 2: Grow an Organic, Evergreen Audience using Podcasting-> www.podcastprouniversity.com  Step 3: Monetize & Scale your Podcast Using Courses and Coaching-> www.podcasttoprofitmastermind.com    Contact us at-> support@stefaniegass.com