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Presented by Matthew Martin of Met Éireann.
In this episode of Detection at Scale, Matthew Martin, Founder of Two Candlesticks, shares practical approaches for implementing AI in security operations, particularly for smaller companies and those in emerging markets. Matthew explains how AI chatbots can save analysts up to 45 minutes per incident by automating initial information gathering and ticket creation. Matthew's conversation with Jack explores critical implementation challenges, from organizational politics to data quality issues, and the importance of making AI decisions auditable and explainable. Matthew emphasizes the essential balance between AI capabilities and human intuition, noting that although AI excels at analyzing data, it lacks understanding of intent. He concludes with valuable advice for security leaders on business alignment, embracing new technologies, and maintaining human connection to prevent burnout. Topics discussed: Implementing AI chatbots in security operations can save analysts approximately 45 minutes per incident through automated information gathering and ticket creation. Political challenges within organizations, particularly around AI ownership and budget allocation, often exceed technical challenges in implementation. Data quality and understanding are foundational requirements before implementing AI in security operations to ensure effective and reliable results. The balance between human intuition and AI capabilities is crucial, as AI excels at data analysis but lacks understanding of intent behind actions. Security teams should prioritize making AI decisions auditable and explainable to ensure transparency and accountability in automated processes. Generative AI lowers barriers for both attackers and defenders, requiring security teams to understand AI capabilities and limitations. In-house data processing and modeling are preferable for sensitive customer data, with clear governance frameworks for privacy and security. Future security operations will likely automate many Tier 1 and Tier 2 functions, allowing analysts to focus on more complex issues. Security leaders must understand their business thoroughly to build controls that align with how the company generates revenue. Technology alone cannot solve burnout issues; leaders must understand their people at a human level to create sustainable efficiency improvements.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Matthew Martin, a 2019 TLC graduate, joins Rafe to discuss his reasons for applying to the TLC program and the impactful first trial he undertook after graduation. Matthew shares how he immediately implemented the methods learned at TLC, focusing on two powerful reenactment stories—one during practice and another in trial—that significantly influenced the outcomes. This episode delves into the transformative impact of TLC's teaching methods, illustrating how they can dramatically enhance legal advocacy.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Ed Hunt from ESB Networks speaks to Eithne Dodd as the cold snap continues while Joe Caulfield catches up with Liam Fitzgerald, owner of Wild Encounters and Matthew Martin, Forecaster with Met Éireann, gives an update on weather conditions and what to expect in the coming days.
Matthew Martin, Met Éireann // Liam Galvin, Fine Gael Councillor in Abbeyfeale in Limerick // Dr. Máire Finn, Clare based GP
Met Éireann has issued a status yellow low temperature and ice warning for the whole country, which will take effect from 6pm this evening until mid-morning tomorrow. And the cold weather may continue over the weekend and in to next week. For more, we're joined by Matthew Martin of Met Éireann...
In Part 2 of our exclusive interview with Matthew Martin, we learn about the urgent need for help for children in Honduras. Matthew discusses the impactful work of Project E15, an initiative dedicated to supporting vulnerable children in Honduras, and the ways we can make a difference. This conversation sheds light on the challenges these children face and how your support can help change their lives for the better.
Presented by Matthew Martin of Met Éireann.
This jumps into the middle of a conversation between Sabbath Lounge and Matthew Martin. Stay tuned for another Sabbath Lounge Interview! This is part one of more to come. Project E15 is dedicated to rescuing widows and minors from the darkest corners of poverty and abuse. We provide holistic care by meeting their physical, emotional, and spiritual needs, offering a pathway to rehabilitation, education, and faith. With a focus on Christ-centered values and a loving, biblical family structure, we foster hope and transformation in their lives. Join us in making a lasting impact and providing opportunities for healing and growth. Learn more about our mission and how you can be part of this life-changing work. https://www.projecte15.com/ https://www.canva.com/design/DAGY2SvjVfg/pnVv9q0Kuam91xRRZ0wyrQ/view?utm_content=DAGY2SvjVfg&utm_campaign=designshare&utm_medium=link2&utm_source=uniquelinks&utlId=hddb79eede1
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
The single serve coffee industry has a recycling problem: too many pods, not enough recycling providers. My guest today is going to tell us how his company aims to solve this problem by manufacturing compostable coffee pods. Matthew Martin is the VP of Innovation at Pod Pack Int'l. He's second generation, growing up in the business with his father, who co-founded Pod Pack in 1996. In 2018 Pod Pack Intl. joined LongueVue Capital (“LVC”), which galvanized the company's potential to generate attractive returns while being accountable for their social and environmental impact.
Presented by Matthew Martin of Met Éireann.
We are seeing a 42F in the emergency room who underwent a laparoscopic sleeve gastrectomy 11 days ago. The operation was uneventful, and she had a negative airleak test. She had an uneventful postoperative course and was discharged on POD 1. Her medical history is significant for hypertension and hyperlipidemia, and he has no other surgical history. She has been able to keep up with her clear liquid diet. She complains that this morning she experienced abdominal and palpitations. You note her vitals show a mildly elevated blood pressure and her latest heart rate is 120s. Join Drs. Matthew Martin, Adrian Dan, Crystall Johnson-Mann, and Paul Wisniowski on a discussion about initial evaluation and management of bariatric patients with internal hernias. Show Hosts: Matthew Martin Adrian Dan Crystal Johnson-Mann Paul Wisniowski Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen
Presented by Matthew Martin of Met Éireann.
Met Éireann has issued a weather advisory for the entire country and warned of “exceptionally high supermoon spring tides” and a possibility of flooding in coastal areas. We get more information on this advisory with Matthew Martin, Forecaster with Met Eireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
You get called to see a consult in the middle of the night. It is a middle-aged woman with a bariatric history, and she says her stomach is smaller but doesn't know the name of the operation. She developed worsening abdominal pain after dinner and it's been getting worse. She's not peritonitic, but she's clearly in discomfort. Is it cholecystitis, diverticulitis, pancreatitis, marginal ulcer, or an internal hernia? What do you do? Join Drs. Matthew Martin, Adrian Dan, and Paul Wisniowski on a discussion about initial evaluation and management of bariatric patients with internal hernias. Show Hosts: Matthew Martin Adrian Dan Paul Wisniowski Show Notes 1. Initial Evaluation a. Focused history and physical, labs, and imaging i. Presenting symptoms may vary and include: nausea, emesis, and abdominal pain ranging from vague to severe. ii. A basic lab panel can aid in developing the diagnosis and guide resuscitation. iii. CT of the abdomen and pelvis with IV and oral contrast can assist in identifying intra-abdominal pathology iv. Reviewing the previous operative report is beneficial to have a framework of the anatomy, i.e. type of bariatric surgery, and configuration of small bowel limbs (ante- vs retro-gastric and ante- vs retro-colic). 1. According to a 2019 study, 40-60% of closed defects had reopened at time of re-exploration v. If the patient is peritonitic with abdominal pain, they should be treated similarly to any patient with an acute abdomen with emergent exploration. b. CT Imaging i. A mesenteric swirl sign with twisting of the soft tissue and mesenteric vessels with surrounding fat attenuation has been shown to have a sensitivity of 78-100% and specificity of 80-90%. Other findings include: a Bird's beak, dilation of roux or biliopancreatic limbs, SMV narrowing, and displacement of JJ limb to the RUQ and can be used to support the diagnosis of internal hernia ii. An experienced radiologist familiar with bariatric anatomy has been shown to have a positive predictive value to 81% and negative predictive value to 96% at radiologically diagnosing internal hernia. iii. A CT scan can provide insight for a suspected diagnosis but it cannot rule out internal hernia c. Nasogastric/Esophageal Tube i. Use judiciously based on patient's presenting symptoms ii. Placement should be done by the surgical team iii. This may mitigate the risk of aspiration during intubation. 2. Operative Management a. Entry should be dependent on the comfort of the operating surgeon. i. Veress entry into the abdomen with dilated bowels may lead to increased injuries. ii. Optiview allows for direct visualization of each layer of the abdominal wall. Focusing on twisting the trochar and limiting perpendicular pressure. iii. Hasson entry also allows for direct visualization but may be limiting in bariatric patients with thick abdominal walls b. Exploration – a systematic approach i. Start with evaluation of the gastric pouch and run the roux limb to the jejunojejunostomy, and examine Petersen's and mesojejunal defects. ii. Follow the biliopancreatic limb to the ligament of Treitz iii. Lastly, identify the terminal ileum at the sail of Treves and run backwards to the jejunojejunostomy iv. This will allow for examination of all possible defect and possible intussusception at the jejunostomy c. Defect Management i. All defects should be closed, with studies demonstrating reduced rates of internal hernia when defects are closed with a running suture. There is no strong evidence to support the use of a specific suture material. 1. The use of suture is superior to other methods of closure such as metallic clips, fibrin glue, mesh, or abrasive pads. 2. A barbed suture can be considered. d. In a patient with unfavorable anatomy or those unable to tolerate pneumoperitoneum surgeons should consider early conversion to open exploration 3. Postoperative Care a. Patients are started on ERAS protocol with limited narcotic use, same day mobilization, early oral nutrition with advancement, and no nasogastric tubes or foley catheters b. Patients with bowel resection and those with suspected postoperative ileus may benefit from judicious advancement of diet. 4. Pregnancy a. Pregnant patients with history of anastomotic bariatric surgery are at increased risk of internal hernia especially in 3rd trimester due to loss of intra-abdominal space b. Evaluation of a pregnant patient should include abdominal imaging. i. In a non-acute setting, an MRI abd/pelvis can be considered. ii. Patients with abdominal pain presenting to the Emergency Department should undergo CT imaging. iii. The risk of radiation to a fetus, especially beyond the 1st trimester, is limited. Based on the CDC guidelines, a human embryo and fetus are sensitive to ionizing radiation at doses greater than 0.1Gray. The amount of radiation from a typical CT range from 0.015 to 0.034Gray depending if it is multiphasic or not; well below the guideline level. c. It is important to discuss with women of child bearing age the risk of internal hernia during pregnancy with anastomotic bariatric surgery 5. Outpatient Presentation a. Half of patients with internal hernia will present in outpatient setting often >6 months after initial operation with complaints of intermittent nausea, vomiting, and abdominal pain b. Workup includes: CT abd/pelvis with IV and oral contrast, Upper GI series, EGD, and a RUQ ultrasound based on their symptoms c. If diagnostic testing is equivocal, proceed with diagnostic laparoscopy to mitigate the risk of internal hernia with bowel ischemia. **Introducing Behind the Knife's Trauma Surgery Video Atlas - https://app.behindtheknife.org/premium/trauma-surgery-video-atlas/show-content The Trauma Surgery Video Atlas contains 24 scenarios that include never-before-seen high-definition operative footage, rich, original illustrations, and practical, easy-to-read pearls that will help you dominate the most difficult trauma scenarios. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out more recent episodes here: https://app.behindtheknife.org/listen
Presented by Matthew Martin of Met Éireann.
8 P.M. HourWe had our finger on the pulse of Monday's top stories. Dan kicks off the program with a variety of guests that included:-Senior attorney in the Division of Marketing Practices of the Federal Trade Commission's Bureau of Consumer Protection, Elsie Kappler on how to avoid popular scams this holiday season.-Matthew Martin of End Hunger New England on their end of year goals and hopes for 2024.-Director of small business success at Constant Contact, Dave Charest on Boston's holiday market at Snowport.-Seven tips to Avoid Pigging out at Holiday Parties with Dr. Julie Gatza.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
Presented by Matthew Martin of Met Éireann.
To close or not to close - that is the question! Internal hernias following bariatric surgery can be a vexing source of delayed postoperative morbidity. Join Drs. Matthew Martin, Kunoor Jain-Spangler, Adrian Dan, and Vincent Cheng for this EXCELLENT Journal Review in Bariatric Surgery. Article #1: Stenberg 2023 - Long-term Safety and Efficacy of Closure of Mesenteric Defects in Laparoscopic Gastric Bypass Surgery Two mesenteric defects are created during Roux-en-Y gastric bypass (RNYGB) Petersen's Defect Jejuno-jejunostomy mesenteric defect Consensus does not exist regarding the standard of care for mesenteric defect closure (e.g., closure of one or both defects, material used for closure). Risks of leaving defects open: internal herniation with or without bowel ischemia Risks of closing defects Kinking the bowel (especially near the jejunojejunostomy) leading to obstruction Chronic abdominal pain This article discusses a randomized controlled trial of obese patients undergoing bariatric RNYGB Randomized into two groups: a closure group and a non-closure group Followed patients for 10 years with 95-96% follow up rate Results analyzed using a Cox proportional hazards regression that included risk factors like BMI, total weight loss at 1 year after surgery, and the other Highlighted outcomes Within the first 30 postop days, there was a higher rate of SBO in the closure group (1.3%) compared to the non-closure group (0.2%). This was attributed to kinking of the jejunojejunostomy After 30 postop days and up to 10 years, reoperation rates for SBO were higher in the non-closure group (14.9%) compared to the closure group (7.8%). This trend was consistent regarding each site of mesenteric defect. No significant differences between the two groups regarding chronic opioid use as a metric of chronic abdominal pain. Article #2: Nawas 2022 - The Diagnostic Accuracy of Abdominal Computed Tomography in Diagnosing Internal Herniation Following Roux-en-Y Gastric Bypass Surgery Unless there is an indication to immediately operate on a RNYGB patient in whom internal herniation is suspected, computed tomography (CT) is the recommended diagnostic test This article is a meta-analysis of 20 studies published between 2007 and 2020 that analyzed the accuracy of CT or detecting internal hernias in adult patients who underwent RNYGB for morbid obesity. A collective total of 1,637 patients were included. Accuracy was determined by comparing diagnostic CT with exploratory surgery or the combination of negative CT and a negative 90 days follow-up Internal herniation was defined as presence of herniated small bowel with or without obstruction or ischemia through a visible opening at the mesenteric defect Results Pooled sensitivity of CT was 82% and specificity was 85% Positive predictive value of CT was 83% and negative predictive value was 86% CT signs with the highest sensitivity (sensitivity of finding) Venous congestion (79%) Swirl sign (78%) Mesenteric edema (67%) 15% risk of an internal hernia even with a negative CT scan In conclusion, CT can provide useful information, but these are just additional data points to consider in the overall evaluation of a patient. Surgeons should still have a low threshold for diagnostic laparoscopy even with negative CT findings If you liked this episode, check out other bariatric episodes here: https://behindtheknife.org/podcast-category/bariatric/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.