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Tyler Hoffman returns to the show to discuss diagnostics and observability data in embedded systems. We catch up on his life after startup acquisition, explore the hows and whys of keeping product data separate from operational data, and consider the realities of fleet management at scale. Tyler is the co-founder of Memfault. Memfault was acquired by Nordic Semiconductor about a year ago. While Nordic has nRF Cloud as a smaller scale solution for Nordic devices (~100 devices), Memfault will continue to maintain support for non-Nordic platforms as well. During the discussion, Tyler advocates for a "device-in-control" philosophy, emphasizing that edge devices should retain the intelligence to manage their own firmware updates and telemetry. We also discuss the practical constraints of remote fleet debugging, outlining why tools built for high-bandwidth web infrastructure will quickly bankrupt an IoT company, and identifying exactly when a project is too low-bandwidth, or too small, to justify an external observability platform. Christopher shares his recent experiences with Memfault which leads to a discussion of chunks, flash memory buffers and MDS. The Memfault Diagnostic Service (MDS) is a standardized way for BLE devices to send the chunk payloads to a gateway device (mobile phone) which can then forward the data to the Memfault cloud. If you want a deep dive into the reasoning around starting Memfault, Tyler was on Embedded.fm episodes 390: Irresponsible At the Time and 395: I Can No Longer Play Ping Pong. Reaching back into the archives, Elecia, Tyler, and Phillip Johnston were on the Memfault Coredump Sessions podcast, a special crosspost with Embedded.fm, episode 451: From Concept to Launch You can also find technical deep dives on Memfault's Interrupt blog. "What we do makes a difference and you have to decide what kind of difference you want to make." – Dr. Jane Goodall, Reason for Hope: A Spiritual Journey. Transcript
"We typically think of the disease progressing for our higher-risk patients because many of them already start with increased blasts or a lot of dysplasia. And they have these chromosomal variants that make them prone to evolving into acute myeloid leukemia (AML). With them, we can anticipate that they are going to progress to AML. And that's what we're trying to prevent. It's kind of like a biologic evolution and not a switch," ONS member Sara Tinsley-Vance, PhD, APRN, AOCN®, nurse practitioner and quality-of-life researcher at Moffitt Cancer Center in Tampa, FL, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about long-term myelodysplastic syndrome (MDS) considerations for oncology nurses. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by June 19, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to management of long-term side effects related to myelodysplastic syndrome and its treatment. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 415: Myelodysplastic Syndrome Treatment Considerations for Oncology Nurses Episode 411: An Overview of Myelodysplastic Syndrome for Oncology Nurses Episode 256: Cancer Symptom Management Basics: Hematologic Complications Episode 220: Oncologic Emergencies 101: Febrile Neutropenia and Sepsis Clinical Journal of Oncology Nursing articles: Exploring Experiences of Bereaved Caregivers of Older Adult Patients With Acute Myeloid Leukemia Family Caregiver Preparedness: Developing an Educational Intervention for Symptom Management Incorporating Nurse Navigation to Improve Cancer Survivorship Care Plan Delivery Oncology Nursing Forum article: An Integrative Review of Sex Differences in Quality of Life and Symptoms Among Survivors of Hematologic Malignancies ONS book: BMTCN® Certification Review Manual (second edition) ONS course: Psychosocial Dimensions of Cancer Care™ ONS Learning Libraries: Survivorship Learning Library Hematology, Cellular Therapy, and Stem Cell Transplantation Survivorship Care Plan Huddle Card American Association of Colleges of Nursing End-of-Life Nursing Education Consortium (ELNEC) American Cancer Society: Living As a Myelodysplastic Syndrome Survivor American Society of Hematology Aplastic Anemia and MDS International Foundation: MDS Toolkit Blood Cancer United: Myelodysplastic Syndromes Family Caregiver Alliance HealthTree Foundation Inspire: MDS Support and Discussion Community Myelodysplastic Syndromes Foundation To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "When our higher-risk patients have disease-related progression, their [malignancy] can transform to AML. And we know this occurs in about one-third of our patients and is one of the most serious late effects. Even in lower-risk disease, we have this worsening marrow failure with or without increasing blast, where [patients] may have just started out with anemia, then they also develop neutropenia and thrombocytopenia. And as those counts worsen, we usually know that their disease is progressing." TS 2:47 "The golden rule is looking at the blood count but also looking at the patient and how they're doing over time. The backbone of MDS monitoring is the complete blood cell count with the differential. What you're looking for is trends over time. How many units of blood are they receiving, what threshold are you going to transfuse them at, and how many units of blood are they getting at a time? ... And then paying attention to the absolute neutrophil count for infection risk. [Another] really important piece of when you look at the differential with patients is seeing if they have any abnormal cell counts. Do they have circulating blasts? Are those monocytes going up? If you start to see blasts circulating or increasing monocytes, then their disease could be changing, even if they have low-risk disease." TS 15:58 "For lower-risk disease, we're paying more attention to their quality of life, how the patient's tolerating therapy, trying to help them stay safe over the long haul, and starting them on iron chelation if it matches that patient and they can have access to those drugs. ... For higher-risk disease, if the patient's goal is to be cured and not to progress to AML, you want to get them to transplant if that's [also] one of their goals. If they do evolve into AML, try and see what treatment matches best for them." TS 22:28 "You want to start early for patients who have febrile neutropenia—that's really important when a patient is an hour or two away from a center where they can get started on antibiotics. So, you have to think outside the box. What can we do to keep them safe? ... I know this group in Alaska that's in our advisory meetings and they try to facilitate transportation to Seattle. That's the closest academic center to them. Collaborating with telemedicine appointments, starting earlier, developing that strong relationship with patients, and contacting them between visits [can help patients living in rural areas]." TS 25:22 "I think the biggest [psychosocial challenge] I see is a lot of unmet anxiety and depression counseling. A lot of times, [patients are] losing their place in their family because they're the ones that need all the help now. Also, the uncertainty that goes along with the diagnosis. There is communication skills counseling, and End-of-Life Nursing Education Consortium (ELNEC) has a lot of training for communication skills and how to really talk to patients. Not that we take the place of a psychologist, but just being able to talk to somebody can go a long way. And if we can get training for that, we can help more patients." TS 31:15
Your Impostor Syndrome Isn't Going Away. Here's Why That's Actually Good News.Imposter syndrome gets talked about like it's a beginner's problem, something you grow out of as your career matures. Katy's here to tell you that's not how it works.After 20 years in leadership, scaling businesses, sitting in boardrooms and speaking to thousands of people on stage, she still has weeks where she questions everything. And she's not alone. 78% of UK business leaders and 80% of MDs admit to feeling out of their depth, they're just not saying it out loud.This episode isn't for people just starting out. It's for experienced leaders who've already proved themselves and are still quietly wondering if today's the day someone finds them out.Katy shares how being made MD of Social Chain at 32 (six months into the role) brought her impostor syndrome crashing to the surface, what working with a therapist taught her about the stereotype she was unconsciously leading from, and why the impostor never fully disappears, no matter how much you achieve.But here's the reframe: what if it's not supposed to? What if your impostor syndrome isn't a flaw to fix, but a signal to follow?In this episode: The three ways impostor syndrome shows up in experienced leaders (and why we dress it up as high standards) Why your impostor is actually a growth indicator in disguise The "boost folder" technique that takes five minutes and changes everything How to close the gap between the leader you think you should be and the leader you actually are You're not on your own. And you never were.
Ric Sinclair is the CEO of Cotiviti, an enterprise healthcare software and data company that serves hundreds of health plans — including the top 25 in the country — across payment integrity, interoperability, risk adjustment, value-based care, and member engagement, touching coverage for over 300 million patients and members. Cotiviti pairs algorithms and AI with thousands of clinical nurses, MDs, and content experts in a human-in-the-loop model, working across the full administrative ecosystem that moves between payers, providers, patients, and pharma. Ric's core conviction is that healthcare's central problem isn't a data problem or a technology problem — it's a coordination problem, and what the system has never had is a true infrastructure layer to tie it together. Cotiviti isn't trying to pick a side between payers and providers; the bet is that a neutral party sitting in the middle can drive fair, transparent outcomes and pull down the trillion-plus dollars of administrative waste in U.S. healthcare.We discuss:Why healthcare's core problem isn't a data problem or a technology problem — it's a coordination problem, and what it actually takes to build the first infrastructure layer the system has ever hadThe real difference between owning a decade of data assets (and the Edifecs integration) and becoming the infrastructure the industry runs on — and where Cotiviti is in that build todayHow "human in the loop" works at scale — pairing AI with thousands of nurses, MDs, and content experts so every claim is reviewed fairly and problems get predicted before they happenWhy Ric's answer to AI isn't "cut the 10-person team to 2" — it's "take all 10 and do what 50 could," and what that augment-don't-replace math means for client ROIHow you build trust and accountability into an AI workflow rather than bolting it on — and who's accountable when models start shaping decisions about claims and careHow to sit in the neutral middle between payers and providers who don't trust each other — and what it takes to build something both sides actually believe is fairWhat Ric learned as a working drummer in Nashville before healthcare found him — leading without the spotlight, making others better, and why simplicity is a discipline that transfers straight into businessWhat a truly differentiated healthcare platform looks like five years out — and the test Ric uses for what "winning" means: a family of five at the dinner table who never have to think about the administrative machinery behind their care—Brought to you by: Sage Growth Partners — Value-focused strategy and marketing for growth-driven healthcare organizations. — Where to find Jared: • X: https://x.com/jaredstaylor • LinkedIn: https://www.linkedin.com/in/jaredstaylor/
I'm here to help. I want you and your families to have your best life, happy and healthy. Just because we're trained to trust institutions blindly and not speak out, or even question, doesn't mean that's a safe philosophy to follow. I have been conveying the same message, the same warnings on video and podcasts for over 7 years. We need to free ourselves fro this cultish ritual of poisoning by shots and pharmaceuticals. Please make the change. Give the 90 Essential Nutrients a test drive for at least 3 months and see what it improves for you. In addition, become a member of Dr. Glidden's membership site so when you need him, he can communicate to you what homeopathic remedies to add to help right your ship when it goes off course. I have had life changing, life improving results since I began taking the AzureWell nutrients, and listening to Dr. Glidden's advice. He's helped me through kidney stones pain-free and told me what to take to dissolve the stones so it didn't cause excruciating pain. He's where I go when I want a problem solved. I haven't been to an MD in years. I like solutions, not poisons and suppressive measures that never address the root of the problem. Typically that root is related to a mineral deficiency. I can lead you to the water. It's on you to drink. Join Dr. Glidden's Membership site here:https://leavebigpharmabehind.com/?via=pgndhealthCode: baalbusters for 25% OFFMake Dr. Glidden Your DoctorUse Code BB5 here for your 90 Essential Nutrients:https://www.azurestandard.com/shop/brand/azurewell/2326The Azure Whole Food Essential Nutrients are 1. Whole Food Multivitamin, 2. Alaskan Cod Liver Oil, 3. Fulvic-Humic Energy Blend, 4. IP6 Supreme. I also recommend adding the Core Copper.Use code BB5 for your discount.Become a supporter of this podcast: https://www.spreaker.com/podcast/ba-al-busters-broadcast--5100262/support.
Along life's winding roads we've each worked tirelessly to hone our skills and ultimately become the excellent clinicians we are today. But what happens when being great in the OR isn't enough? Each week on About the Rest, Joe Rodriguez, DNAP, CRNA, gets into the weeds on the definitive podcast for fellow CRNAs and MDs who want to understand how our profession actually works behind the scenes… warts and all. The spiritual sibling of the award-winning podcast Anesthesia Deconstructed, About the Rest takes a commentary-driven approach to facing the infrastructural obstacles that keep holding us back. Because the hard truth is… although our clinical skills are essential, the business of healthcare far too often treats them as commodities. Unapologetically inside baseball, join the podcast where together we become leaders, gain influence, and hone the skills nobody taught in our programs to take control of our careers. To Learn More Visit: ww.abouttherest.com Got a Question? hello@abouttherest.com Learn more about your ad choices. Visit megaphone.fm/adchoices
Les annonces de Philippe Tabarot sur Drive to ZeroChoose France 2026 — Près de 3 Mds€ pour la logistiqueCMA CGM Notre-Dame, le porte-conteneurs recordAxe MeRS — Augustin de Romanet remet son rapportPremier hub portuaire multi-services de Géodis au HavreFM Logistic & Motul — Un hub de 45 000 m² à Nangis SAF : les États-Unis manqueront leur objectif 2030 TER hydrogène —Dernière ligne droite pour les rames d'AlstomToulon et l'A154 : les dossiers chauds de la FNAUT Vélo cargo — Le porte-bagages devient un outil logistique Union TLF — Bilan statistique sur le fret européen Les 3e Voiles du Maritime Agenda de la semaine : 8 juin : Journée mondiale de l'OcéanLe 9 juin : Euro Supply ChainDu 9 au 11 juin à Paris, Mobco 2026 9 au 13 juin : sessions techniques à l'OMILe 11 juin 4e Journée Mer & Défense à ToulonUn podcast écrit, réalisé et monté par Nathalie Bureau du Colombier @2026Voix générique Eddy CreuzetVignette Thomas Billet.Un podcast écrit réalisé et produit par Nathalie Bureau du ColombierVoix générique Eddy CreuzetVignette Thomas Billet.Visit our website : https://transpod.fr/Subscribe and leave a review! Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.
Tomorrow's podcast is a little different. We're doing a two-part episode. First, we're diving into some of the biggest health and peptide mistakes I'm seeing right now...mistakes that can waste money, delay healing, and in some cases actually make health challenges worse. Then we're going to celebrate one of our amazing CHI members, Susan, who chose a very different path. Instead of guessing. Instead of chasing symptoms. Instead of jumping from supplement to supplement, practitioner to practitioner, or peptide to peptide. She decided to understand what was actually standing in the way of her health. Susan completed advanced testing that revealed she was carrying and actively releasing pesticides, plastics, mold toxins, and other environmental toxicants. She learned where to focus. She followed a roadmap. And she took action. Before I tell you more about Susan's story, here's what we'll cover in today's episode:
High‑risk MDS and AML continue to challenge clinicians, with limited durable responses and few options for older or treatment‑refractory patients. In this sponsored episode of The Top Line, host Stephanie Butler is joined by Dr. Amer Zeidan, Professor of Internal Medicine at Yale School of Medicine, to unpack new ASCO 2026 data that are drawing attention across the myeloid malignancies field.The discussion focuses on mesutoclax, a novel oral BCL‑2 inhibitor evaluated in combination with azacitidine. Dr. Zeidan breaks down early findings showing a 100% objective response rate with CR rate of 40% per IWG 2006 criteria and 90% composite complete response with CR in 60% in treatment‑naïve high‑risk MDS, along with strong efficacy and encouraging safety signals in AML, with over 80% composite CR, and with potent activity in TP53 mutant, as well as zero death within 30 or 60 days and rapid cytopenia recovery.Listeners will hear how mesutoclax’s potency, selectivity, and pharmacokinetic profile may overcome key limitations of existing BCL‑2 inhibitors, and what these results could mean for future frontline treatment strategies.See omnystudio.com/listener for privacy information.
Most B2B businesses are spending half a million pounds or more a year on a go-to-market model that doesn't work. Not because the people running it aren't capable, but because the model itself is broken. Tools that don't talk to each other. Teams whose job is to operate those tools. Outbound sequences that get ignored. And an ROI that is, almost universally, terrible.In this episode, Nigel Maine breaks down the structural cost of fragmented GTM, explains why serious B2B buyers do not respond to interruption-based selling, and shows — with live data — what a broadcast-driven commercial infrastructure actually produces when you stop chasing and start being visible. He also reveals something that happened this week that is one of the most commercially significant developments in B2B AI right now: a 1.53 million word IP corpus, indexed and queryable in BigQuery, producing show scripts, LinkedIn posts, and investor communications indistinguishable from what the founder would have written himself.If you run a B2B business with a complex sale, senior buyers, and a decision-making cycle that takes months — this is for you. Watch to the end for the data.What this episode coversThe real cost of fragmented GTM — tools, headcount, agencies, and ad spendWhy serious B2B buyers research anonymously and don't respond to outboundThe Mere Exposure Effect and why consistency builds purchase-ready trustWhat sX Live actually is and why broadcast is not the same as video or webinars90-day data: 1,668 PDF downloads, 35% email open rate, 7.8% LinkedIn engagement — all organicHow Claude wrote this show script from a 1.53 million word indexed IP corpusThe difference between using AI as a chat tool and deploying AI as a component of a commercial operating systemWhat a queryable BigQuery telemetry layer gives you that no CRM canWho this model is for — and who it isn'tWho should watchB2B founders, CEOs, MDs, and commercial directors who are questioning their current GTM spend and want to understand whether a broadcast-driven, AI-augmented infrastructure could replace what they're currently paying for.Take the next stepDownload the GTM Reset, GTM Landscape, or GTM Architecture Audit PDFs at salesxchange.co.uk — or email nigel@salesxchange.co.uk to talk about what this looks like in your business.
Jay Dhaliwal, founder of Super Patch, joins Mind Pump to break down one of the most unconventional technologies in health and wellness — haptic patches that alleviate pain, improve sleep, boost athletic performance, and more with zero compounds or drugs. Sal opens up about being deeply skeptical until reviewing the peer-reviewed studies, and the guys walk Jay through the entire origin story — from a passion project to help his mother with MS, to 17 years of research, $40 million of his own money, and 16 published peer-reviewed studies. They cover the neuroscience of how skin receptors communicate with the brain, what the studies actually show (50% pain reduction, 85% sleep improvement, 5–8% athletic performance gains in D1 athletes), and why half the teams in the NFL are already using the product. Super Patch — https://mindpump.superpatch.com $30 off — no code needed, discount automatically applied at checkout (price drops from $99 to $69) SPONSORS Seed Daily Synbiotic — https://seed.com/mindpump Code: 25MINDPUMP — 25% off first month MAPS 15 BOGO — https://maps15bogo.com Buy 1 get 1 FREE — limited time (all 7 MAPS 15 programs same price) LINKS Mind Pump Store: https://mindpumpstore.com Maps Fitness Products: https://mapsfitnessproducts.com Instagram: @mindpumpmedia 0:00 - Intro 1:48 - What is Super Patch? Sal's skepticism and what changed his mind 5:13 - How this compares to when red light therapy first came on the scene 8:02 - Jay's origin story — his mother's MS and 17 years of research 13:16 - The Loretta Z database — quarter million EEGs and the search for normative neural networks 20:10 - The first breakthrough — identifying the vestibular response network in 2014 24:47 - First proof: comparing his mother's EEG against the normative database 27:43 - From brainwaves to skin receptors — how Braille unlocked the next phase 30:08 - The 2010 discovery of piezo two ion channels and skin sensation science 34:07 - The first product — socks that improved balance and gait by 31% 36:59 - Brain mapping 35 people with the world's leading EEG expert — the impossible result 39:07 - How the pattern in the patch is designed — 1200 iterations of micro tooling 43:52 - 2017 Japan study — skin sensation is permanently imprinted on the sensory cortex 45:46 - From socks to patches — how pain and sleep networks were identified 49:01 - The first clinical study — 50% reduction in perceived pain, 70% reduction in interference scores 53:02 - Sleep study results — 85% of subjects went from bad sleep to good or great sleep 56:51 - Pain relief comparable to 400mg Advil — without the drug 58:38 - Stress patch — 33% reduction in perceived stress, 24% improvement in mental health factors 1:01:35 - D1 athlete study — 5–8% improvement in lower extremity power at University of Arizona 1:03:55 - Half the NFL is already using Super Patch 1:04:17 - Stacking patches — which combinations work best for athletes 1:05:30 - Neuroplasticity — why your baseline gets higher over time with consistent use 1:07:52 - Full product lineup — pain, sleep, stress, focus, libido, immune, Zen flow state & more 1:11:28 - Appetite suppression pilot — 20% improvement in resting metabolic rate 1:13:32 - 5000 MDs in America now recommending Super Patch
A big cast of pod characters at the game for our final MDS of the season as Albion flopped on the pitch yet stumbled over the qualification line regardless. So get those chain mail underpants on order and settle back for a summer of anticipation as we await the draw for the Conference Play Off Stand or fall! UTA! So long Solly!!! @BrightonRockPod on BlueSky (and Twatter) brightonrockpodcast@gmail.com Part of the Sport Social Podcast Network that can be found in all their glory at this rather suitable address: www.sport-social.co.uk Please follow us for automatic downloads of new episodes and if you want to make us really happy please rate us five stars on Apple and any other platforms that provide the opportunity to do so! Why not write a review while you are at it?! ;0). All this helps our rankings and improves our chances of getting exciting guests onto the show. Also we are now on Patreon, so if you happen to be inclined to extreme acts of generosity we'd greatly appreciate any monthly donations, great or small, to help us run the pod as well as we can. Go to www.patreon.com/BrightonRockPod for details and to sign up. NB Our content will remain freely accessible to all listeners regardless. Humble thanks! Learn more about your ad choices. Visit podcastchoices.com/adchoices
Laís Abramo, secretária Nacional de Cuidados e Família do MDS, conta em entrevista como medidas do governo federal oferecem alternativas para diminuir as jornadas exaustivas das brasileiras.
Send us Fan MailThe 2027 Ram 1500 Rumble Bee brings HEMI power back in a big way, but the most interesting detail may be what Ram removed, and what it kept. The new Rumble Bee 5.7L HEMI drops eTorque and auto start/stop, yet still uses MDS cylinder deactivation to help with fuel economy during light-load driving.In this week's Pickup Truck Talk news recap, Cory breaks down why Ram made that choice, what it means for enthusiasts, how the Rumble Bee differs from regular 2027 HEMI-powered Ram 1500 trucks, and why this new muscle truck lineup could be one of Ram's smartest moves yet. Also in the news: a new Nissan Frontier trim, more recalls, and new aftermarket products worth checking out.#PickupTruckTalk #RamRumbleBee #Ram1500 #HEMI #TruckNewsGet your Screen ProTech screen protector:https://screenprotech.com/timJoin our Patreon: https://www.patreon.com/c/pickuptrucktalkSupport the show
Self-Worth and Money: The Hidden Money Beliefs Holding You Back - Ep. 149 Pt. 1. How does your self-worth affect your income? In this episode, Rebecca Robertson sits down with life and leadership coach Rose Latham to explore how childhood money stories, class identity and unconscious beliefs shape what we earn and what we think we deserve. From growing up as "the posh kid" to feeling out of place at Oxford and turning down corporate opportunities in favour of stacking shelves, Rose's story reveals how deeply our sense of worth is wired into our relationship with money. Rose Latham is a life and leadership coach for CEOs and MDs who want to lead more strategically without carrying the business alone. But before she got there, she had to confront a deeply embedded belief system that kept her playing small financially, even with a degree from Oxford. In Part one of this two-part conversation, Rose shares how growing up as the "posh family" in a Wiltshire village shaped her early money identity, how arriving at Oxford flipped that narrative completely, and why she walked away from every corporate graduate opportunity without even attending a single evening. Rebecca draws powerful parallels from her own experience, from working in a bank at 19 to navigating class assumptions around ambition. Together they dig into how the education system reinforces a "work hard = compliance" narrative, why the teaching profession fed Rose's low self-worth, and what it really costs when you try to fill a hole in your identity with a salary. What You'll Learn: How childhood money stories create unconscious limits on what you earn Why class identity shifts can shake your confidence at critical career moments The real reason "working hard" doesn't always lead to financial reward How self-worth and salary are connected (and what to do about it) Why the UK education system may be reinforcing unhealthy money beliefs Connect with Rose Latham: LinkedIn: https://www.linkedin.com/in/roselathamcoaching/ Facebook: https://www.facebook.com/rose.latham.127 Instagram: https://www.instagram.com/roselatham.lifecoaching/ Chapters 0:00 Introduction and welcome 1:30 How do you measure your self-worth? 3:15 Growing up as "the posh family" in Wiltshire 6:40 Arriving at Oxford: from big fish to small fish 11:20 State school kids sticking together at uni 15:00 The milk round: "This isn't for me" 20:30 Working at Tesco's and pubs instead of KPMG 24:00 Rebecca's parallel story — working in a bank at 19 27:45 Graduating with no experience: a humbling reality check 31:30 The power of networks and a free trip to Brazil 35:50 Learning Spanish at 26 and five years in South America 39:00 Coming back to the UK and going into teaching 42:30 How teaching fed the low self-worth narrative 46:00 "You could have paid me double and it wouldn't have been enough" #SelfWorth #MoneyMindset #AcceleratingYourWealth #FinancialPlanning #WealthCoach #MoneyBeliefs #PersonalFinance #LeadershipCoaching #WomenAndMoney #ClassAndMoney --------------------------------------------------------------------------------------------------------------------------------- Connect with Rebecca Robertson and the Podcast: Subscribe for weekly wealth-building strategies: https://www.youtube.com/@rebeccarobertsonifa Instagram: https://www.instagram.com/rebecca_robertsonifa & https://www.instagram.com/acceleratingyourwealth LinkedIn: https://www.linkedin.com/in/rebecca-financial-advisor Facebook :https://www.facebook.com/RebeccaRobertsonwealth www.evolutionfinancialplanning.co.uk Disclaimer: This content is for educational and informational purposes only and should not be construed as financial advice.
ПАРТНЕР ВЫПУСКА:ZiJin RG Gold — https://www.rggold.kz/Здоровье - золото!В ГОСТЯХ: Галым Чуашев – главный псих среди нас, Димаш Сабитов – псих, который больше всех страдал под солнцем и в ночи, Сания – девушка-псих, самая быстрая из казашек на MDS, Паке (я) – автор подкаста и псих по мнению друзей и подписчиков. Гульжан с нами в выпуске нет, но она не менее психованная в целом и была с нами душой на записи.Наши инстаграмы:https://www.instagram.com/zhivoi_starkhttps://www.instagram.com/jailaubekovashttps://www.instagram.com/sabitov90https://www.instagram.com/sakenova01https://www.instagram.com/paveltentserblogИНТЕРЕСНЫЙ ФАКТ: расскажите об этом в комментариях лучше вы?!Ссылка на YouTube, чтобы оставить комментарий: https://youtu.be/eP9iROp_j3o?si=oWaJ9V_7DA9nF9CSКУПИТЬ МЕРЧ ПОДКАСТА:https://t.me/beguibastaСПИСОК АКТУАЛЬНЫХ НА МОМЕНТ ПУБЛИКАЦИИ ПАТРОНОВ:Sergey Li (Founder)Konnykh Andrey, Alfirad AskarovSergey Fyodorov, Marat Shaimardanov, Kirill Rozengurt, Anna Yashchikova, Ильяс ЖумагуловRunza, Erjan K, Филипп Полутин, Gaukhar Zhumabek, Pedro Vizuette Castro,Kamila Kussainova, Himmel GB, Lena MKO, Rin4a, Жания Кубашева, ВикторСтуденин, Артем СолонухаМихайлова Ирада, Лунный Цветок, Aleksandr Morozov, Максим Потехин, Aknur Orazbekova, Дмитрий Аксёнов, Irina MasanovaDaniyar Zhaketov, Raushan Baizhanova, Галия Ситтыкова, Sairan_Run, VladimirАйгерим Мурзалина, Айдар Турмухамбетов, Шах, Даулет Суинтаев, Алина, Мадошка,Дмитрий Докучаев, erb22, Diana Smagulova, Евгения Онбаева, Snowcat,Kristina Run FitСТАНЬ ПАТРОНОМ и услышь своё имя в каждом эпизоде, получай эксклюзивы ивыпуски раньше других, участвуй в розыгрыше мерча, получи его мгновенноили стань сразу моим гостем подкаста: https://patreon.com/tentserДля тех, кто из России: https://boosty.to/tentser/donateМоя страничка: https://www.instagram.com/paveltentserblogМой телеграм: https://t.me/tentserСаунд: Turan - "Argymaq"Монтаж: https://www.instagram.com/alisher_gumarВизуал: https://www.instagram.com/izhankinn
Amid a backdrop of relentless operational challenges and high leadership turnover, there's a new professional standard for nursing home administrators. The American Association of Post-Acute Care Nursing has officially launched its first certification designed for nursing home administrators to ensure facility CEOs have the specialized tools and credentials necessary to foster stable, high-quality care environments. In this episode of McKnight's Newsmakers, Denise Winzeler, RN, LNHA, director of education and certification strategy for AAPACN, explains the organization's move into the administrative suite after years of setting the bar for MDS and nursing certifications. Hosted by McKnight's Long-Term Care News Senior Editor Kimberly Marselas, this conversation highlights the program's ability to bridge clinical knowledge and operational excellence. The certification is about more than just checking a box, says Winzeler. It speaks to the evolution of the profession and leaders' growing needs for regulatory savvy and emotional intelligence. "This role demands more than just competence. It demands heart, vision and unwavering commitment," Winzeler says. "The future of long-term care really depends on leaders who will rise to meet these needs." The certification is designed as an on-demand, online course tailored for the busy schedules of active administrators. To qualify, candidates must be licensed with at least two years of experience in the post-acute care realm and pass a final exam with a score of 80% or higher. To learn how the program aims to transform resident care and professional development — and to check out how its three primary pillars may enhance a career — listen to the complete episode. You can also find more details in the McKnight's article and on AAPACN's website. Hosted by Simplecast, an AdsWizz company. See https://pcm.adswizz.com for information about our collection and use of personal data for advertising.
"We want to make sure that we discuss the details of the treatment and what treatments there are, whether it's an oral drug, whether it's a subcutaneous injection or an IV injection, [the patient's] potential for responding, whether this treatment is curative or supportive, and what the number of visits are. All of those different pieces of information that go into the decision-making process are really important," ONS member Sara Tinsley-Vance, PhD, APRN, AOCN®, nurse practitioner and quality-of-life researcher at Moffitt Cancer Center in Tampa, FL, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about myelodysplastic syndrome (MDS) treatment considerations. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by May 15, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge about the treatment considerations for MDS. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 411: An Overview of Myelodysplastic Syndrome for Oncology Nurses Episode 256: Cancer Symptom Management Basics: Hematologic Complications ONS Voice articles: FDA Approves Luspatercept-Aamt for Anemia in Adults With MDS Infection Prevention for Oncology Nurses Manage Cancer-Associated Anemia With Erythropoietin-Stimulating Agents Whole-Genome Sequencing May Guide Treatment Choices for AML and MDS Clinical Journal of Oncology Nursing articles: Reducing Effects of Hospital-Associated Deconditioning in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation Resilience in Older Adults Diagnosed With Cancer and Receiving Chemotherapy Targeted Drug Therapies: Beyond Blood Counts and Chemistries Oncology Nursing Forum article: Frailty in Patients With Hematologic Malignancies and Those Undergoing Transplantation: A Scoping Review ONS books: BMTCN™ Certification Review Manual (second edition) Hematopoietic Stem Cell Transplantation: A Manual for Nursing Practice (third edition) ONS course: Hematopoietic Stem Cell Transplantation™ ONS Learning Library: Hematology, Cellular Therapy, and Stem Cell Transplantation ONS Symptom Intervention resources: Prevention of Infection: General Prevention of Infection: Transplant Aplastic Anemia and MDS International Foundation: MDS Drugs and Treatments Blood Cancer United: MDS Treatment HealthTree Foundation Myelodysplastic Syndromes Foundation To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "The goals that I try to consolidate to make sure they're consistent with the patient's goals are to improve their counts, especially the anemia or cytopenias. If they're getting blood transfusions, we want to reduce the number of transfusions that they receive because we know that's linked to reduced overall survival, and it really impacts quality of life. ... And then for high-risk patients, it's a more serious discussion because we know that they are the ones who can progress to acute myeloid leukemia (AML). And we're trying to delay progression to AML. That means we're trying to improve their survival and we're also trying to manage their cytopenias and decrease their infection risk." TS 2:28 "If we look at approvals for low-risk disease and high-risk disease, those were really made based on the Revised International Prognostic Scoring System (IPSS-R) and sometimes the International Prognostic Scoring System (IPSS). Under those classification systems, when we think of lower-risk MDS, we think of patients who are primarily anemic but don't have increased blasts in their bone marrow. ... For higher-risk MDS, we want to have that discussion with those patients because their life expectancy is much shorter than patients with lower-risk MDS. We want to see if hematopoietic stem cell transplant would be something that they would be interested in if they don't have a lot of comorbidities and are relatively healthy." TS 11:41 "There are a lot of things to consider—[patients'] blood counts, comorbidities, whether they're frail, and what their goals are. There are some patients where there's no way they would want to go through transplant. And some patients want to be cured, so it just depends on your patient." TS 14:22 "I think of hematopoietic allogeneic transplants as a treatment for more of the patients with higher-risk MDS. ... With the Molecular International Prognostic Scoring System (IPSS-M), a patient can have pretty good blood counts and not have increased blasts in the bone marrow. You could send them for a transplant referral upfront without having to give them additional treatment. ... There is a recent publication that said if a patient doesn't have more than 10% blast, you could refer to transplant as a first option. ... Also, if you had a lower-risk patient who is relatively young and doesn't have any other treatment options, this would also be a patient that you could refer to transplant to see if we could care for them, and then they wouldn't have to be getting transfused all the time." TS 21:12 "I think that we often think low-risk, no treatment needed, but it depends on the person. They often need ongoing supportive care to manage their symptoms even if they're not getting treatment. And just because we're not treating them, active observation, bringing them in to see how they're doing, if they've had infections, if their blood counts are changing, that is paying attention to them and doing something. Just because they're low-risk doesn't mean they don't need anything and we can just schedule for a one-year follow-up." TS 26:30
Special discounts up for AIE Melbourne (LS discount) and AIE World's Fair (group discounts up to 25% - CFPs still open for Autoresearch and Vertical AI) Cya there!Abridge did not start as an “GPT wrapper”. It was founded in 2018, years before the Cambrian explosion of AI application layer companies. OpenAI launched ChatGPT publicly on November 30, 2022 and by then, Abridge had already spent years doing the unglamorous work of building trust for one of the highest context, most important workflows in healthcare: the conversation between a patient and a clinician.Abridge's original wedge was clinical documentation. Listen to the visit, generate the note, reduce the clerical burden, and let clinicians spend more time with patients instead of the EHR. By focusing on how doctors actually document, how health systems actually buy, how EHR integration actually works, how clinicians verify outputs, and how missing context during a visit turns into downstream friction across billing, prior authorization, quality, and follow-up, the adoption of LLMs became a force multiplier on a workflow already optimized for sensitive context gathering.The company has scaled fast: Abridge says it is projected to support 80M+ patient-clinician conversations this year across 250 large and complex U.S. health systems, with support for 28+ languages and 50+ specialties. It raised $300M at a $5.3B valuation in June 2025, after a $250M round earlier that year.Today, Janie Lee and Chaitanya “Chai” Asawa of Abridge join us for another crossover pod with Redpoint's Jacob Effron (who is on the board of Abridge) to dive into how Abridge is building the clinical intelligence layer for healthcare starting with ambient documentation, then expanding into clinical decision support, prior authorization, payer/provider/pharma workflows, and eventually real-time agents that act before, during, and after the patient conversation. We go inside the product, data, infra, evals, workflow, privacy, and org design choices behind bringing AI into one of the highest-stakes enterprise environments from 100M+ medical conversations and specialty-specific evals to real-time alerts, EHR integration, de-identification, clinician-scientist teams, and why healthcare may solve some of the hardest AI problems first.We discuss:* Why Abridge started with clinical documentation, “pajama time,” and saving clinicians 10–20 hours a week* The transition from ambient scribe to clinical intelligence layer: save time, save money, and save lives* Why conversations between patients and clinicians may be the most important workflow in healthcare (patient visit summary feature)* Chai's “healthcare-coded Glean” framing: context is king, but healthcare raises the stakes on safety, evals, and rollout* Why Abridge wants AI to feel like “air conditioning”: always in the background, but only interrupting when it truly matters* The prior authorization example: turning a denied MRI weeks later into real-time guidance while the patient is still in the room* Why payer policies, EHR data, medical literature, and hospital-specific guidelines make the problem hard, and also create the moat* How Abridge thinks about ambient form factors: mobile, desktop, in-room devices, nursing workflows, multimodality, and future AR* The multi-sided healthcare customer: CMIOs, CFOs, CIOs, clinicians, patients, payers, and pharma* The hardest AI problem at Abridge: high-quality, low-latency, low-cost real-time support in a high-stakes clinical setting* When Abridge uses frontier models vs proprietary models, and why its unique data from medical conversations matters* Why “every agent is a coding agent underneath,” and how the EHR can be thought of as a filesystem for healthcare agents* How Abridge approaches personalization across individual doctors, specialties, and health systems* Why “AI slop” is AI without context, and how edits, memories, and clinician preferences create a data flywheel* Abridge's eval stack: LFDs, LLM judges, in-house clinicians, third-party evaluators, specialty-specific evals, and progressive rollout* HIPAA, PHI, de-identification, one-way anonymization, customer contracts, and learning from healthcare data safely* What changes when you operate at 100M+ conversations: reliability, cost, post-training, model routing, and infrastructure optimization* Why the same clinical conversation can serve doctors, patients, payers, pharma, and future clinical-trial workflows* How Abridge works with EHRs, and why deep interoperability is table stakes for clinician adoption* Why healthcare AI has regulatory tailwinds, why 80/20 does not work here, and why high-stakes domains may drive AI forward* Why Abridge embeds “clinician scientists” into product and eval teams* What Chai learned from Glean about search, quality, and durable AI infrastructure* Why the future of AI infra may look like context layers, event-driven systems, Kafka, Temporal, sockets, CRDTs, and tools built for humans* Why Janie changed her mind on “PRDs are dead,” and why crisp written clarity matters more in complex AI products* How Abridge uses Claude Code, Cursor, and coding agents internallyAbridge:* Website: https://www.abridge.com/* X: https://x.com/AbridgeHQJanie Lee:* LinkedIn: https://www.linkedin.com/in/janiejleeChaitanya “Chai” Asawa:* LinkedIn: https://www.linkedin.com/in/casawaTimestamps00:00:00 Introduction and what Abridge does00:02:05 From ambient documentation to clinical intelligence00:04:04 Clinical decision support and context as king00:06:57 Alert fatigue, proactive intelligence, and prior authorization00:12:36 Ambient AI form factors and healthcare customers00:16:59 The hardest AI problems in healthcare00:18:26 Frontier models, proprietary data, and model strategy00:21:07 The EHR as a filesystem for agents00:24:03 Personalization, memory, and clinician preferences00:30:40 Evals, LLM judges, and progressive rollout00:36:47 HIPAA, de-identification, and privacy00:39:21 100M conversations and operating at scale00:44:10 EHR integration and the clinical intelligence layer00:46:39 Healthcare regulation, latency, and high-stakes AI00:50:11 Clinician scientists and long-tail quality00:53:04 Lessons from Glean and durable AI infrastructure00:57:03 The future of agentic healthcare workflows00:57:34 PRDs, product clarity, and building serious AI products01:03:11 AI coding tools at Abridge01:04:06 OutroTranscriptIntroduction: Abridge, Clinical Intelligence, and the Latent Space x Unsupervised Learning CrossoverSwyx [00:00:00]: Okay. This is a special crossover Latent Space Unsupervised Learning pod.Jacob [00:00:07]: Very excited to do this.Jacob [00:00:08]: At this point, we get together once a year.Swyx [00:00:10]: Once a yearJacob [00:00:11]: And this is a fun occasion to get to do it on.Swyx [00:00:13]: I really wanted to talk to Abridge but I felt very underqualified because healthcare is not something we cover very intensely. It just so happens that Redpoint's our big investors and supporters of Abridge.Jacob [00:00:27]: Anytime you want to have a portfolio company on your podcastJacob [00:00:29]: Please, by all means.Swyx [00:00:31]: So we'll introduce our guests. Chai and Janie, welcome to the pod.Janie [00:00:34]: Thanks for having us.Chai [00:00:35]: Thank you.Janie [00:00:35]: We're excited to be here.Chai [00:00:36]: Thank you.Swyx [00:00:36]: So for listeners, what do you guys do, just to situate you guys in the company?Janie [00:00:42]: Abridge is a clinical intelligence layer for health systems. We really started with documentation and building for clinicians and as we think about reducing the burden that clinicians have, they're spending 10 to 20 hours a week on documentation. There's a massive doctor shortage in the country. We also think that conversations between patients and clinicians are probably the most important workflow in healthcare. It's where care is given and received but if you think about the 20% of our GDP that goes towards healthcare, almost everything is a derivative of that conversation, whether it's the claim, the payment, the actual diagnosis given, the treatment. And we've started with a conversation to reduce the burden for doctors on documentation but we're really excited about the path ahead as we become this broader clinical intelligence layer.Chai [00:01:34]: I'm Chai. I work on clinical decision support at Abridge.Swyx [00:01:37]: Yes.Chai [00:01:37]: And so as Janie said, we're uniquely situated where we started off with the clinical note. What I'm really excited about and where we're expanding towards is what are all the things you can do before the conversation, during the conversation and after the conversation if you did have access to all the context about patients, payer guidelines, medical literature and put that together and to serve, how healthcare could look fundamentally different.Swyx [00:02:01]: And that's the context engine that you guys have?Chai [00:02:04]: Yes.Swyx [00:02:04]: Is that what it's called? Okay.Swyx [00:02:05]: So historically, as I understand it, the company started in 2018. A lot of people would be familiar with the AI voice notes form factor that doctors would be “Well, do you consent to being recorded?” It replaces handwriting and what have you. But it sounds like more recently there's been a big transition in the company. Tell me about the broader transition.From Documentation to Clinical Intelligence: Save Time, Save Money, Save LivesJanie [00:02:26]: So from a transition perspective, we really think about our journey as The first act was: how do we help save time? And that's where a lot of that original product was.Swyx [00:02:37]: By the way, one of those interesting statsSwyx [00:02:39]: On your landing page was, doctors spend time after hours.Janie [00:02:43]: They call it pajama time.Swyx [00:02:44]: Why is that pajama time?Janie [00:02:46]: Doctors after work in their pajamasSwyx [00:02:48]: In their pajamas. OhJanie [00:02:49]: At home are just writing and catching up on their notes every day.Janie [00:02:53]: Some of our favorite customer love stories, we have a Slack channel called Love Stories. We have clinicians telling us, “Abridge has helped us, from retiring early or we're now finally able toJanie [00:03:06]: go home and eat dinner with our kids for the first time.”Chai [00:03:08]: Save the marriage in some cases.Swyx [00:03:10]: One of the quotes was “We're not divorcing anymore.”Swyx [00:03:12]: I'm asking, “Why?”Swyx [00:03:14]: Because they're working too much.Janie [00:03:16]: But, in terms of where we're going and where we're expanding, we really think about our second and third acts around how do we help health systems save and make more money. Health systems are operating with record-low operating margins. It's getting harder and harder to serve patients and they have regulatory, some tailwinds but also a lot of headwinds coming their way and AI is ripe for helping on the saving and make-more-money piece. And then ultimately, how do we help save lives? The fact that our software and our product is open millions of times a week before, during and after a patient walks in the room, gives us massive opportunity with products like clinical decision support, which Chai is building but so many others to improve patient outcomes and probably one of the most important workflows and problems to be going after right now.From Glean to Healthcare: Context Is KingJacob [00:04:04]: One thing that's interesting, Chai, is you came over to Abridge from Glean and clinical decision support, which for our listeners is, in the context of a visit, helping a doctor figure out the right type of care. It's really a search problem in many ways, going through lots of different data sources. Very analogous to your previous role as one of the earliest engineers over at Glean. I'm sure a lot of our listeners are curious what's similar about the problems that you're going after now and what feels different, now that you're in healthcare.Chai [00:04:33]: Very similar. Taking a step back, with every wave, there's a lot of very similar patterns that happen across different products. A lot of social networking products look the same. A lot of credit-based products look the same. And we're seeing that very similar in the agent era with many companies, of course, in Redpoint's portfolio and so forth. And the key insight between both companies is that you have amazing models but context is king. Context is what puts them to work. So I see it in a lot of ways, a lot of similarities in this is a healthcare-coded version of Glean but the differences are really interesting. A couple things that come to mind. First and foremost, the rigor of the setting we're in. The downside risk is extremely high here in healthcare. It can be fatal in some cases. You prescribe something that the patient is allergic to for example. Whereas at Glean, it's “Oh, you got the question wrong.” It wasn't the end of the world in most cases. And so what does that mean? That shapes our evaluation strategy, both offline evaluation, progressive rollout and there's a lot more we could go into there. Second thing that comes to mind is, vertical versus horizontal. In both cases, there's a large variance but when Glean is, it's a much more horizontal company, there's a variance of personas, companies that you're working with. We also have a variance of personas, different types of specialties, different hospital systems. But the variance is a little more narrow. So from a product perspective, you're able to focus far more, especially when you have a maturing technology and you're building new products that never existed before. It lets you go after them much more easily and especially in healthcare where so many problems were solved with labor and process, that it's extremely ripe for AI to keep helping augment and enable. And the final thing that's really interesting, Abridge specifically compared to many other companies in the AI area, is the modality we started with where we're ambient and we're always listening in the background. And many more AI products will go that way but it's how we started. And that's the greatest form of AI we can create, AI that's seamless. You're not looking at your screen. It's always there. It's always helping you out and being proactive. The Jarvis vision that, every hackathon I went to over the past decade, there was always a Jarvis competitor. But Abridge very much started from the opportunity and continues to go that way.Ambient AI and Alert Fatigue: When Should the Product Interrupt?Jacob [00:06:57]: One thing that is super interesting then from a product perspective is you have this always-on seamless in the background and then you have to decide when you break the wall almost and say, “Hey, clinician, you might not have thought about X,” or whatever it is that you want to do. And in healthcare traditionally there's been this idea of alert fatigue and a million pop-ups and then a doctor just ignores all of them. It's probably a pattern that a lot of builders are thinking through now. How do you think about the right way to intervene or to pop up in a doctor visit?Janie [00:07:26]: It's such a good question. Alerts are notorious in healthcare specifically. Over 90% of alerts are ignored. The first and most important thing is context is everything, as Chai alluded to and I also think about how do we go from being reactive alerting to really proactive intelligence at the point at which it matters most. One thing we like to say is we want our product to feel like air conditioning. It should be in the background just making things better and if there is something that has great clinical risk and we're acutely aware that intervening now and not later is incredibly important, we should decide to act. But if you think about proactive versus reactive, instead of alerting a clinician during a visit when they're with their patient having a pretty serious and sensitive conversation, how do we prep a clinician before they walk into the room with that patient? And so historically, clinicians might have to manually go through charts with a patient that they've had over the course of months or years and they'll try to suss out what are the things they should be doing. You can imagine a world with Abridge. We'll summarize all of the most recent context for you, tell you based on the reason for a visit the patient is coming in for the types of things you should be discussing. And so you're going into that conversation prepped rather than walking in cold to that patient visit and then having this product interrupt you five or 10 times throughout the visit. And there might be times where it's really important to interrupt. We have a product called Prior Authorization and so this is when you may go into a doctor's office with knee pain. They'll prescribe you an MRI and so many of us have had this experience before, where in four weeks you'll get a call saying, “Hey, Sean, that MRI that you were prescribed wasn't approved and why don't you come back in? We'll figure it out.” In a world with Abridge, we might choose to quietly but still alert a doctor in that visit. And alert is probably not even the word we would want to use. Before a patient leaves, we would want to tell the doctor, “Hey, Doctor, before Sean leaves, you should ask him, has he had physical therapy and has his pain lasted for more than six weeks? Because the Aetna plan that he's on in California requires six things. We've already confirmed four of them have been met ‘cause we have all the context. But these two last criteria, if you can address with Sean before he leaves the room, we could guarantee that your MRI is approved before you leave.” And so when you think about clinical usefulness, impact to the patient, there are instances in which if we can catch a doctor while the patient is still in the room, as we think about save time, save money, save lives, we get to check all of those boxes. But when doctors have 15 minutes between visits, we have to be really thoughtful about when it matters.Prior Authorization: Reducing Latency in CareChai [00:10:23]: There's this interesting product opportunity AI has is reducing latency in the world. For example, prior authorization is an example of where care gets delayed and so great AI can reduce that. And the problem with alerts before partially is a technical problem: the quality of your alerts really matters. They're going to get ignored if you get alerts that... Similarly in engineering, where they're noisy alerts that you can't act on. But if you can make really high-quality alerts with both the context, as Janie said, and really high-quality models, then you can create a whole other game.Janie [00:10:53]: And I really like that experience because it starts to tease apart, what makes this so hard and unique. One, to make that prior authorization example possible, think about all the data that you need to have. You need to integrate with the electronic health record to know all of the patient context. Do we have access to your previous labs, previous imaging? And then to match you and to know that you're on Aetna, we have to collect all of the different payer policies and they vary by state. Some of these payer policies live on websites. Some of them live in unstructured 50-page PDF files.Jacob [00:11:31]: I thought this episode wasJacob [00:11:31]: To make sure we didn't scare people from healthcare.Janie [00:11:34]: But when you think about the things that make it hard, it also gives you the moat.Janie [00:11:39]: And then the second is the AI and the model quality we need to be able to hang our hat on. And so the bar, similarly when I worked at Opendoor, I worked on pricing models. Every outlier wiped out the margins of 30 and so similarly here in healthcare, the bar for accuracy is so high. And then I'd say the last is workflow is everything. If insurance companies deploy AI, it typically happens too late and this is when you have the notorious comical examples of AI just fighting each other when it's too late. But if we can pull forward the use of both the AI but also the ability to solve problems when the patient's in the room, you can start to collapse what typically takes weeks or months after your visit, ideally down to minutes or real-time. And it's where healthcare is both very difficult but also extremely rewarding if you can crack it.Product Form Factors: Mobile, Desktop, In-Room Devices, and ARSwyx [00:12:36]: Just to get some baseline on the form factors, because I've seen some videos on your website and stuff. You guys talk a lot about ambient AI. Is it primarily on the phone? Is there any other form factor that people get Abridge in? Is there an Abridge room setup where it's always on? I don't know.Jacob [00:12:55]: An Abridge podcast studio.Janie [00:12:58]: Primary form factor is mobile and desktop. UsuallyJanie [00:13:00]: Clinicians are walking in and out of rooms with mobile but at the end of the day, when they're closing out their notes or wanting to prep for the day ahead, they might use desktop. We have been having a lot of really interesting partnership conversations with a lot of these in-room device companies as you think about the power of multimodality and even more data, as you think about all of what is not captured today. It is fascinating to think about, especially even as we go into building and scaling our nursing product. It's one where nurses constantly, as they're walking in to check in on a patient for two minutes or maybe even 30 seconds,Janie [00:13:43]: Starting an Abridge experience is probably going to take longer than the visit. And so what can we do with in-room devices that are always on starts to raise really interesting and fun product questions.Swyx [00:13:54]: I was thinking, the way in tech companies we have all these Google MeetSwyx [00:13:58]: And other things, we might as well set up entire rooms with just Abridge tech.Chai [00:14:02]: Very much. AR glasses and related form factors are also relevant: how do we bring the information to the clinician in real-time without a screen, while still letting them focus on the patient?Swyx [00:14:18]: Do you think they want that? I'm skeptical of AR, but I'm curious what you've tried.Chai [00:14:26]: Admittedly, it's not a near-term product roadmapChai [00:14:29]: By any means. I'm being far-fetched.Jacob [00:14:31]: There's some sick AR stuff for surgeries.Swyx [00:14:33]: Really?Jacob [00:14:33]: When people are trying to visualize, you're about to make an incision but you want to see, what the cut might look or what the body might look like inside and they can layer in imaging.Swyx [00:14:43]: That's cool.Chai [00:14:45]: At some point in the future.Janie [00:14:46]: But there are a lot of our largest customers and at the largest health systems integrating already and so even as we think about building into it, unlocks a lot of product capabilities.Swyx [00:14:57]: And just to establish the terminology. Sorry, and I know I'm asking basic questions somewhat for myself but also for the audience who might beHealth Systems, Buyers, Clinicians, Patients, and PayersSwyx [00:15:05]: Less integrated. When you say health systems, it's like the Johns Hopkins, the Kaiser Permanentes.Janie [00:15:09]: Mayos, the Kaisers of the world.Swyx [00:15:10]: These are your customers, right? And the outcome that you deliver for them is happier doctors, reduced cost of processing, reduced mistakes. It's weird in a sense that I feel like there's also, a secondary customer, the customer of the customer and I don't know if you — do you think about it that way?Janie [00:15:28]: The other interesting and complex part of building product is we have our buyers, who are the chief medical information officersJanie [00:15:39]: The chief financial officers, the CIOs of these large health systems. Our users today are clinicians but if you think about who downstream is impacted, it's patients. And so as we build, with every product in mind, we think about who we're building for, who the secondary user is and what does that mean either in terms of experience, security compliance, ROI that we have to make tangible. And so like you said, time savings is one of them. But for CFOs, they care a lot more than just time savings. We have to show for every dollar you put into Abridge, because you have more compliant documentation or because you have fewer queries coming from your billing team, we save or add real dollars to your bottom line or top line, are things that we're constantly thinking about because of the dynamic across all three sets of users.Chai [00:16:32]: There's a whole other axis too with the payers and pharmaChai [00:16:35]: as well. Connecting all these three big stakeholders in healthcare isSwyx [00:16:39]: Do the payers ever see your data? Sorry, the payers meaning the insurers, right?Chai [00:16:44]: Yes.Swyx [00:16:44]: They also see Abridge data?Chai [00:16:47]: NoSwyx [00:16:47]: Like the direct integration to you guysChai [00:16:48]: They wouldn't see the raw Abridge data but when you're working together on something like prior authorization, whatever information they need, we'd communicate to them.Jacob [00:16:59]: That's cool. I would love to dig into the AI side. You still have a lot of problems on the AI side. And so maybe to start at the highest level, what's one of the hardest problems you have to solve in AI at Abridge today?The Hardest AI Problems: Quality, Latency, and CostChai [00:17:11]: To make things simple, let's take, building off the prior auth example. So one thing Janie talked about is okay, this data is all over the place and there's this combinatorial explosion of procedures, payer policies and even sometimes different health systems. There can be some cross-product of all of these different considerations you have to take into account. But what's really hard about this problem is doing it real-time in the conversation. So, in any AI product, usually the three KPIs you care about are quality, latency and cost. Now, what we're saying is we want you to do this real-time in the conversation, guiding the clinician. How do we do it in a way that does not break the bank? But we're using — But we also need very intelligent models because you're working with this cross-product of data and this, all this context layer as well. So you need high intelligence and high-quality because you don't want the alert fatigue but you also need to be fast and cost-effective. And so that's where a lot of clever engineering goes. It's okay, without getting into all the details here, can you model these policies in some intermediate representation or other things that you can do that can make this problem tractable? And of course, the Pareto frontier is always changing but we are also trying to do this now.Model Strategy: Third-Party Models, Proprietary Data, and Medical ConversationsJacob [00:18:26]: What implications has that had for what you take off-the-shelf and say, “ what? We don't need to be world-class at X. We'll just take this from the model providers or from some infrastructure player,” and what you're “No, this is where we spend most of our time focused on”?Chai [00:18:38]: This is, the fun challenge in AI?Jacob [00:18:42]: It changes every three months? SoChai [00:18:42]: Of course, with the shifting landscape, we try to be extremely thoughtful on predicting the trends of where third-party models are going and where we can uniquely go. And, sometimes when you talk about AI models, we're the models are just going to get infinitely better. But I don't think... It may be in the grandness of time you could say that but, within every month, every quarter, there's specific ways they're getting better. They're training on a lot more, coding data to be better coding agents, for example. And soChai [00:19:14]: We have to think about where are the things that won't — unique data that we're uniquely training on or to step back a little, where is a proprietary model bringing advantage to us is if it can give higher quality or lower cost and latency for similar quality, very similar to many other companies. And when we can do that is when we have proprietary data. So, for example, we have on the order of eighty million or hundreds of millions now getting close to of medical conversations.Jacob [00:19:44]: It's insane.Chai [00:19:45]: This is a unique data set. And this data set, it's very interesting because this data set is effectively a large part of the trace between the patient and the provider. That's where the quote-unquote debugging happens in healthcare. We have these traces at scale, as in as, our CEOs even called it, an exhaust that comes out of our product. And so when you have these traces, that's how you can train better agents on certain use cases, whether it's your transcription diarization use cases or so on or like note generation models and we can do that much cheaper and faster. But we're always also working with these third-party model providers. We closely collaborate with them and that's how we predict where the trends are going. The thing that I think about a lot is that, I know that the model providers are going to train much more on agentic workflows and so forth, so that's great, so that you have a better agentic harness. But the other thing that's interesting is that the model providers, because a large class of the consumer model providers is healthcare queries, that they might, optimize to train a lot of healthcare data to encode the knowledge in its weights. And this is just a great thing for us as well, where the off-the-shelf models can keep bett-getting better at general healthcare information, such that what our strategy is, we have a constellation of models, we can use something for this, that and, we only care about, at the end of the day, the best product experience.EHR as File System: Agentic Workflows and Real-Time InterfacesJacob [00:21:07]: And, you have, overall capabilities improving. I'm curious, as these models get better, is there something you look at and you're “, three months ago, we really couldn't do that but God, the the latest models really allow us to do it”?Chai [00:21:19]: So here's something interesting that I've, been toying with. So all models are... This wasn't super obvious a year ago but now it's become clear and clear that almost every agent is a coding agent underneath the hood? So you give it whatever file system, it can write its own code and so forth. So when you think about within healthcare and the use case that we have, you can think of the EHR effectively like a file system. It's just — it's a storage of all this information. It's a lot of information there that cannot fit into the context window, at least of today's models and you want to use that context effectively for all these product use cases we're talking about. And so if you have better agents that can, manipulate data, read that data, treat it as a file system as we see they're going and we know model companies are investing this way, then that very directly benefits us.Swyx [00:22:09]: Yeah. Okay, cool. Again, just establishing basic things. But we're going back to the model stuff. I'm really interested in double-clicking more on the real-time, element, which is pretty important for both of you. Is it — Is real-time just batches of every one minute, every five minutes? Is that how we do it? Or is there some more native, genuinely real-time in the sense that OpenAI has a real-time API or Gemini has a real-time API?Chai [00:22:35]: Yeah. Yeah. So today it is more on the on the batch basis but there's interestingChai [00:22:41]: Prototypes that we have that we're still not fully, full time, voice in text out or in that sense. But, can you trigger your models, your agents or agentic workflows, depending on the right times in the conversation?Chai [00:22:58]: And so you can imagine, different techniques to bring this latency down and, you want to bring the feedback loop down as much as you can. And so a lot of clever engineering there without fully... Maybe one day we'll do full voice in and text out, train a model to do something like that.Swyx [00:23:15]: You do — People don't want voice in voice out?Chai [00:23:18]: Now we aren't creating experiences that are, during the conversation, inter — It's almost likeSwyx [00:23:25]: Might be too disruptiveChai [00:23:26]: Too disruptive until, who knows, maybe eventually you could have full voice agents once we — the quality and we improve the comfort of the technology. But right now gra — that change is much more gradual and it's more text focus, text out.Janie [00:23:42]: And so much of currently what our product is trying to do is allow a clinician to focus on their patient and maybe at some point but right now patients, clinicians don't want a third voice, at least in a literal voice in that room. And so how do we be there with all the contacts and information ready at hand when there's the right moment?Personalization: Individual Doctors, Specialties, and Health SystemsJacob [00:24:03]: Jenny, one thing I'm curious about is how you think about, personalization in the product. I imagine, every doctor is a special snowflake in their own way, has their own way they like to do things. There are probably a bunch of different approaches you could take to doing that, both within the model layer itself but then also just with clever prompting or engineering. How do youJacob [00:24:20]: Deliver on that?Janie [00:24:21]: It's such a good question. Personalization is massive for us. We think about personalization at three levels. The first is at the individual, the second is at the specialty level and then the third is at the health system or the organization level. To your point, there are a lot of individual preferences. You-When a note is produced, it almost is a reflection that is so deeply personal of a doctor's work and how they give care. And so do they have preferences on things like style? They might want bullets versus paragraphs, really concise versus comprehensive. They also might have phrases that they really like to use or the templates that they want every note to be structured. And, we see it in our feedback all the time. We want two spaces in between sentences or I refuse to use this tool. And so that's something that we've had to build in. And the tricky part is how do you make sure that stylistic preferences don't interrupt accuracy and quality and that's something that we've really had to refine and hone over time. Second is at the specialty level. A cardiologist note or workflow is going to look very different from a dermatologist workflow.Jacob [00:25:32]: I assume cardiology notes are the highest stakes for you guys, given your CEO is a cardiologist.Jacob [00:25:36]: It's “Oh my God, make sure we get this one.”Janie [00:25:37]: Shiv, our CEO, is still a practicing cardiologist. He rounds once a month. And so, first call when we want just quick and easy user feedback too.Janie [00:25:46]: But, specialties require a lot of personalization, both in terms of what does the product look and so we make sure that as new users onboard, we catch that and the product proportionally reflects that. But also on the back end, evals at the specialty level, they are hard-earned to calibrate and get. What does a really great dermatology note look like? What makes it complete? What makes it compliant and billable is very different than a primary care doctor. And so it's not just about what does the product experience look but on the back end tuning and really deepening our understanding for the specialists. What does great output look like? And that's, a problem that we need to calibrate internally, externally, online, offline but, takes lots of cycles but is necessary in a high-stakes environment. And then at the health system level, for products like clinical decision support, you have health systems who've spent years or decades refining their best practices and they want to know, “Hey, we love your clinical decision support product but how do we embed our own hospital guidelines into them to inform clinicians before, during or after a visit what brest — best practices should look like?” And as you think about, deepening moats as well, when health systems, trust us with that data, allow us to productize it and directly into the clinical workflow, makes us a really great partner to health systems who want to build something that truly meets their needs, their practicing guidelines.AI Slop, Memory, and Product Data FlywheelsChai [00:27:23]: And I want to add onto that. The for the clinical documentation problem, it's very similar to AI writing that doesn't feel like your own and then we call that slop. But the way I describe one framing of slop is like AI without context. But we have all that context and both the clinicians, can have it and can guide it. And so part of the other interesting exhaust for us is, memory is, one of these new systems recordsChai [00:27:49]: Almost.Janie [00:27:50]: And we also have all the edits people make on our product and when you think about a data flywheel and how we get better over time becomes really powerful as a mechanism to just going deeper in personalization.Jacob [00:28:04]: It's interesting. I love this idea of working with systems on the guidelines they built up over a long time. I feel like so many of the best AI app companies today are... The question is: How do you take the expertise that a law firm or a bank has built up over many years and then add that as context and also a special sauce over, a an AI tool? And so seems like y'all are really doing that very effectively.Janie [00:28:24]: We're now starting to have our customers ask, “What are other customers doing?”Janie [00:28:28]: “And how are they doing it?”Janie [00:28:30]: And as we think about having visibility across such a large set of care being delivered right now, a really interesting place we could also partner.Swyx [00:28:40]: I'm just curious. I — This may be a nothing question but, how different are health system guidelines from each other? Don't they all converge to the same thing? And if not, where do they differ?Chai [00:28:52]: At a really high level, they're going to talk about very similar things but the difference is probably in some more of the details. “Oh, you should refer to specialists only when XYZ conditions are met,” or so forth and maybe different organizations have different practices and guidelines around that. But high level, talking about similar things but the details are what, of course, that shapes the context and the decisions you make.Swyx [00:29:15]: And this all goes into the context engine and it might affect the notes but maybe not.Chai [00:29:21]: The — For these local pathways, we're definitely thinking about it a little more for our clinical decision support product.Chai [00:29:26]: So yeah.Swyx [00:29:27]: Which is your stuff, yeah.Swyx [00:29:28]: And then the memory which you raised, let's just tell us more about that. What have you tried in memory? What's the structure of the memory? What works? What doesn't work?Chai [00:29:38]: There's, of course, many different ways you could do memory, where it's okay, can you bake it into the model weights or can you do it in some external store? For us, what's interesting is, of course, when you think the models are rapidly changing, whether it's in-house or third-party, baking into the model weights, sometimes you worry that it could be a little throwaway. And so, how do you... You need to find a way that you decompose the problem, the preferences from the underlying models and so forth. The thing we're right now most both that's easiest to start with and we're excited about is having, a separate store for memory, where you have, for example, a memory sub-agent that's, working in the background, figuring out what are the important parts of the clinician's actions that we want to remember for the long term. And then you can also imagine, other things where in the — you have background jobs that are running that are collating these, memories similar to Sleep, of course and what other pattern, patterns products do as well. Learning over all these action, all the action data we have, again, note edits, the conversations they did and the actual transcripts.Evals: LFD, LLM Judges, and Clinical SafetyJacob [00:30:40]: What about evals? How in the world do you... It is such a complex product surface area. We would love to hear you riff on that and also how has that evolved? I'm sure you've gotten better at it, so any learnings along the way.Janie [00:30:50]: From an evals perspective, we, from day one when we build any new product or feature, we think about, what does good look like? And there are table stakes things like clinical safety but then you start to get deeper into what does good quality look like. And when you go into something like our core product, there's stuff like style and completeness and there's things like does this note become something that can be billable, which is very high stakes for a health system. We have a number of ways in which we get confidence for this. We have, internal in-house clinicians who do what we call an LFD process to give us our very first pass at is this or isn't this a good enough output, look at the effing data.Jacob [00:31:41]: LFD?Chai [00:31:42]: That's why I was smiling. I was “Is Janie going to mention what it stands for?”Jacob [00:31:46]: I was not... There's like a million acronyms.Jacob [00:31:48]: How am I supposed to know that I don't? So “Oh yeah, of course, an LFD.”Swyx [00:31:51]: I've never heard of LFDs.Chai [00:31:53]: It's a bridge for sure.Janie [00:31:55]: I got through three days and then I had to ask someone.Janie [00:31:58]: I thought it was just me that didn't knowJanie [00:32:01]: It's our internal process.Swyx [00:32:02]: But look at the data as a meme in ML, ‘cause you tend to not look at it. You just want to look at number go up.Chai [00:32:06]: Exactly.Swyx [00:32:07]: But yes.Janie [00:32:08]: But so, we make sure we look at the data and then as we think about all of the components of good output, we, one, create LLM judges across all of these and we make sure with annotated data and either internal or external evaluators, we feel like these judges are calibrated. And then depending on the stakes, we also work with in-house and third-party evaluators across all of these before we ship any big change. And the goal is, in terms of evolution, how do you go from this process taking months, down to weeks, down to days? Some of it is, a true science and ML problem. A lot of it's also just, hard operational work. Have you planned ahead in terms of what you need? Have you really optimized the capacity that you need across all of the different specialties you need? Have you gotten a really good sense of which third parties are great to work with for what use cases? This takes a lot of domain, expertise and, lots of mistakes and errors in figuring that out. And so as much of it is an ML problem, so much of it has also been operational gains that are hugely important, where domain-specific expertise is everything.Specialty-Level Evaluation and Progressive RolloutsJacob [00:33:23]: But it's funny, ‘cause I feel like people talk about healthcare like it's one giant market and the reality isJacob [00:33:26]: It's, dozens and dozens of sub-markets. And so it feels like in your evals you have to build that up across the board, probably.Swyx [00:33:34]: And is specialization the primary cardinality at... That's the word that comes to mind.Janie [00:33:40]: Sometimes, depending on the product or the use case. And so if we're making a note improvement or feature for a particular specialty, definitely but we have products that are for nurses. We have products that, are really aimed at making the document or the output a lot more billable. And so we'll want to work with coding teams and not necessary clinicians. And so likeJacob [00:34:05]: Coding meaning healthcare coding.Janie [00:34:06]: Yes. Yes.Jacob [00:34:07]: NotChai [00:34:07]: Yes. I see you.Swyx [00:34:07]: Other kinds.Janie [00:34:09]: But is this output proportional to the work that was delivered? Is there sufficient documentation to justify the amount that a health system may end up charging? And so, specialty sometimes but also domain, very different across all of the different products that we're working for. And building out that network is, not easy and is where a lot of our operational investments have gone into.Chai [00:34:35]: And I view a lot of analogies to self-driving cars here, where, part of it is we really want progressive rollout of features to test in the real world is this useful? Is this going to work? One big difference compared to past lives is before I'd build a product, maybe I'd alpha it and then I'd like GA it the next week, ‘cause I'm “Go, move fast, ship,” and whatnot. But the mentality is like you... I want to make contact with the reality as quick as possible but I want a progressive rollout. Because as much as I get as large of an offline eval set, I want the distribution of that to match real-life distribution. And over time, by rolling out early, similar to Waymo has a tagline, “The world's most experienced driver,” another thing that can, at least linearly increase for us is, both the size of our evaluation offline and online, that and it all feeds back.Janie [00:35:25]: Something that's been earned over time, speaking of evolution, is just the trust we've gotten with customers. Historically, a lot of these health systems, when they bring on new vendors, their release cycles are quarters, sometimes twice a year. We've gotten our customers onto monthly release cycles, which is pretty fast for health systems but what is more exciting over the last, call it, few quarters, has been, a subset of our customers have said, “We want to innovate with you. We trust you,” and we have a pretty, decent chunk of our customers who say, “We'll develop with you outside of these monthly release cycles. We have a higher tolerance. We know that the stakes are very high but we want to be the first ones using these products, giving you feedback.” And so for a pretty substantial set of our customers, we've been able to convince them to be able to ship, in this gradual way before GA. Something we talk about a lot internally is, trust is earned in drops, earned in buckets and so we still can't do what I used to do when I worked at Loom. We had 30 million users. I'd just be, rolling out experiments left and. The bar is still quite high for iterative rollout but because of the trust we've earned, we're able to learn at pretty high volume very quickly.Privacy, HIPAA, and De-IdentificationSwyx [00:36:45]: Your scale is still pretty huge.Swyx [00:36:47]: One thing I want to... We were going to go into scale? In a sec. One thing I wanted to call up, follow up on evals, which, again, just coming from a generalist engineer point of view, just thinking through what would people be scared of in doing this, the privacy and HIPAAJacob [00:37:00]: Elements of this. I have zero experience in that. What do you have to do? What is surprisingly not that bad?Chai [00:37:06]: So one thing that's really important here from a compliance perspective is very much that any of the data we use needs to be de-identified, any real-world data we use as a basis of online eval sets we're learning from. And so you have to — And there's, very clear, government guidelines, what counts as PHI. And so we've even have built models that can take, for example, a clinical transcript and remove all the key PHI indicators and so you have a scrubbed/de-identified version. And then once you... And so one thing that's important is first you've got to get confidence in that model in the first place? And prove that out. Because, now you have, multiple probabilistic systems on top of each other.Chai [00:37:46]: But once you have that, then you can train on it use it for evaluation and so forth, provided one of the cool things also that you can do from a business side is the right data contracting as well with your partners.Jacob [00:37:57]: Is the anonymization one way? Once it's done, you cannot undo it? Or is there someoneChai [00:38:01]: YesJacob [00:38:02]: Who holds the master key that can... Yeah, okay. So it's one way.Chai [00:38:05]: It's one way. Yeah.Jacob [00:38:06]: That's how it works. I just wanted to... Because, there's a lot of this, learning from feedback and everything that, you would want to debug more but you can't because you just physically don't allow yourself to.Janie [00:38:17]: Some of it's also written in our customer contracts in terms of who can or can't access PHI data, how long do we retain it,Jacob [00:38:27]: Very goodJanie [00:38:27]: Before it gets de-identified. And so we have a pretty high bar for who can access that PHI data, just to make sure that we always respect our customer data and privacy. But that's something that we partner with our customers on too, to make sure that as we want full, as close to precision as possible in that qualityJanie [00:38:48]: We can still use it.Jacob [00:38:50]: But it'll be fascinating to see how that space evolves? Because you think about, I used to work at a company that, did a lot of healthcare data in the cancer space and if you asked, the average cancer patient, “Hey, do you want people, do you want other patients to be able to learn-”Chai [00:39:03]: Take it.Jacob [00:39:03]: “... Learn from your experience?”Chai [00:39:04]: Take it all.Jacob [00:39:05]: They're “Please.”Jacob [00:39:06]: “I'd love, nothing more than for other people to be able to learn fromJacob [00:39:10]: The experience that I had.” And so in the past it was a lot harder to do that learning. But with this technology, that might really be practical and so it'll be fascinating to see how that continues to evolve.Chai [00:39:21]: There's so much in our data set of 100 million conversations.Chai [00:39:26]: You can imagine things like insights that you can give to the clinician. How could you, oh, how could you have reacted to this? In coaching or insights around, which treatments are effective or, like... Because you have this, again, this data source that was never captured before but that's, where, intuition or experience is created from, going back to this idea that the conversation is the agent of truth.Operating at Scale: Reliability, Cost, and Token EfficiencyJacob [00:39:46]: Back to the 100 million conversations, I feel like you have this insane scale that maybe only a few other AI app companies have and everyone else dreams of. So not everyone has had to confront this yet but maybe just talk about some of the challenges of operating at that scale and what, our listeners have to look forward to if they ever get to this level of scale.Chai [00:40:05]: At large and larger in scale, so of course there's a general, infrastructure reliability. When you... In any given startup, you're building the plane while it's flying. So there's some notion of that. But what gets interesting on the AI and ML side for sure is this, as you get at more and more scale, so one, you have the data to first and foremost do this. But, you start thinking about costs or infrastructure in a whole different way at scale versus, a prototype.Chai [00:40:34]: You can use the most expensive model, you can burn as many tokens as you want but when you're doing 100 million conversationsJacob [00:40:41]: Token max on leaderboards are less upsetting than that context.Chai [00:40:45]: . When you're doing that and so that comes for we have the data and we also have the team that's able to post-train based on this and you can optimize for efficiency, especially in areas where you believe that maybe a lot of the quality headroom is less so and you don't expect the other off-the-shelf models to go that way, such that you want to do, efficiency maximization, in terms of compute and tokens.Jacob [00:41:08]: I feel like you guys live in the future in some way where most use cases today are really just in use case discovery mode, where it's “God, I really hope I can find something that can get to scale,” and so you're always going to use the most powerful model. And then the few things that do get to this level of scale, you start to do those optimizations.Chai [00:41:22]: It's a natural trajectory where it's like zero-to-one, we're not talking about any of these optimizations.Chai [00:41:26]: But when maybe we're in the one-to-100 or so forth, then we're in optimization mode and, what works out really well is you've got all this data from zero-to-one that lets you do this.What Comes Next: The Conversation as the Shared Healthcare PlatformJacob [00:41:36]: That's fascinating. I feel like one thing that's so interesting about the Abridge footprint is that you're in the doctor-patient visit in real-time. I always like to say, there's like probably 50 years' worth of product you could build on top of that. What gets each of you, I don't know, what are you most excited about building, either in the short term or medium term or even, long down the line?Janie [00:41:53]: Something that I get really excited about is that the same conversation can serve so many stakeholders. If you think about the conversation, a doctor needs to know what is the documentation, how do I make sure that this fully represent the care I gave? A patient needs to know, “What the heck just happened? This was really overwhelming. What are my next steps?” A payer needs to know, was this the proper and appropriate care given? A pharma company might want to know why isn't this drug being properly used or is there a good candidate for this clinical trial that I'm about to run? And where I get excited is that our product and our platform and our infrastructure can be the same product across all of those things and start to what's today, separate, very expensive, complex systems that serve each one of these stakeholders in very different ways, start to collapse all of that into a singular platform that enables not just more efficiency across the board but also better outcomes for everyone. And, all of us experience healthcare in probably very painful ways and knowing that there is a world in which we can simplify a lot is really exciting to me and it all starts with the conversation.Chai [00:43:15]: It's interesting. Of it very similar to going back to the KPIs that any AI product cares about. How do you increase quality of care? How do you reduce latency to care? And how do you reduce costs? Which is a huge, in healthcareJacob [00:43:28]: They call it the triple aim in healthcare.Chai [00:43:30]: But very similar to building AI products and the thing that really excites me is when we talk about that latency piece, we talked about one example earlier of prior authorization, can you reduce the latency to care? But you can imagine so much more. Oh, as soon as the lab value gets updated, do you have like a background agent that, kicks off and uses all the context to be “Oh, hey, the patient should do this next,” for example. And of flagging that to the clinician who's always in the loop but reducing that latency, to care. And then you can imagine this is much further down the road but it's like even connecting that to the direct patient and the consumer. And so how can you, how can you build a bridge to all of these things?EHR Partnerships and the Clinical Intelligence LayerJacob [00:44:10]: Very cool. The connections piece is just an ever-growing thing. And one of the key partners is the EHR and I wonder what that relationship is like. Will they, look at this as, something that is valuable enough that they want to own someday?Janie [00:44:29]: Our partnerships with the EHR is, we know that we have to be extremely close partners with all the EHRs who we partner with. Being able to not only pull and push all of the data into the right places is, not only table stakes, if we can't do that, health systems don't want to use us. The second and the reality of today is clinicians spend a lot of their days in the EHR. So much of what allowed us to win in the largest health systems was pretty direct and, very close partnerships with some of the largest electronic health records that allowed us to pull and push data with APIs that weren't ready out of the box. And clinicians want to save clicks. Anytime we introduce a new product that, adds two clicks for them in their day, they're “We're not going to use it.”Janie [00:45:21]: They have 15-minute back-to-back appointments with their patients. They're spending, hours during pajama time doing documentation. Every second and every minute counts and so we really think about being deeply integrated into the EHR as also table stakes to getting real usage and adoption. And anything that we build or introduce, we really talk about earn the right internally a lot, which is we have to provide so much value or save so much time that people will use us. But those are the two things that are close to us, is we know that the product won't be used unless it is deeply interoperable.Chai [00:46:01]: And strategically, to your point, it's like what does EHR want to own versus us? EHRs are really focused on the clinical workflows and so forth but some of the things that we're talking about here, I do these traditionally are outside of the domain where it's oh, connecting pairs and providers together with provider policies or the clinical trial matching, as Janie brought up. And so these are, entirely — we position ourselves as building this entirely new intelligence, clinical intelligence layer across, again, providers, pharma and, payers.Chai [00:46:33]: And so that's a it's a whole different ballgame that we try to playChai [00:46:36]: In combination with them.Jacob [00:46:37]: But it's like a different layer of scope.Healthcare AI Regulation, Technical Depth, and What Changed Their MindsJacob [00:46:39]: I'm curious, you are both relatively newcomers to healthcare. People have these, there's lots of futuristic healthcare AI takes of “Oh, everything will look different.”, now that you've been in healthcare for a bit, you live at the edge of AI, what have you, changed your mind on around this, as you think about what healthcare looks like in ten, 20 years? Any updates to your mental model from the time being close to the problems?Chai [00:47:02]: One thing that IChai [00:47:04]: Was hesitant about before and it's a common thing when I'm trying to recruit engineers that people ask me around, is definitely oh, healthcare, heavily regulated space. And it is, rightfully so. You want to keep, the patients at the end of the day safe. But one of the interesting things that, is a that surprised me how much it is coming to the company is there's a lot of really favorable regulatory tailwinds as well. Where you think about, government really wants interoperability between all these systems that we talked about and so agents can access this information. The government just in January, the FDA released updated guidance on clinical decision support, what I work on in such a way that they used to have guidance from like 2022 that required you to have, mention all these options and do all these other things but it's a very forward and forward-looking way. And so for me, what's been really cool to work on is this, there's this very special moment both in AI in general, we all know that but there's a special moment also regulatory in healthcare as well.Janie [00:48:05]: One thing I would call out is for the very reasons things are higher stakes or, potentially considered more difficult in healthcare, it's where some of the hardest AI problems will get solved first, just because the bar is so high. When I first joined, I was “Oh, this is where we'll be on the tail end of where, all of the AI innovation will be able to be applied.” But when you think about, zero error evals or multi-step workflows that have really low tolerance, a lot of the innovation will happen here just because we have to or else we can't ship.Jacob [00:48:42]: ‘Cause like in other domains, you'd much rather just solve the 80%-is-good-enough problems firstJanie [00:48:46]: 80/20 doesn't work hereChai [00:48:48]: And building off that, traditionally, there was a bit of stigma that, oh, healthcare companies are not that interesting from a technical perspective or I've seen that or faced that myself. But these are really hard and fun problems from a pure technical perspective beyond just the impact. How do you bring the latency of this thing down and make it really high-quality?Reducing Latency: Clinical Workflows, Agents, and Implementation RealityJacob [00:49:07]: How do you bring the latency of things down?Chai [00:49:10]: Yeah. Yeah. Yeah. So okay, let's answer the latency question. And maybe hopefully not too redundant with some of the things I've said earlier but some part of it is with any latency, you have to like what is, what is really your bottleneck. In a lot of workflows, it's sometimes it's the model itself. And so that's where like our data flywheel, our post-training team and so forth come in so that can you make the models far more efficient. So that's one aspect of latency. But there's whole other aspects of latency where it's okay, on top of that, if you use a constellation of different models, can you use — can you first use like a — it's like thinking fast and slow. Can you use a cheap, fast model that triages and hands it off to a larger model where you get more intelligence and so forth and so all theseChai [00:49:56]: Clever tricks to make it work.Chai [00:49:58]: And by the way, we are totally — we also realize that the parameter frontier is changing and so these tricks will — may not get us to where we want to be in five years but we need to if we want to build a useful product right now.Jacob [00:50:11]: Should we go to the quick-fire or you want to ask more about Abridge? We can stuff everything that's not Abridge into the quick-fireSwyx [00:50:16]: I don't mind. I was — I feel like Janie was on the topic of more long tail stuff, which isSwyx [00:50:21]: Not the eighty/twenty thing and that really matters. And I'll —, if you have any tips or cool stories or just general approaches that have worked for you that's interesting to dig into.Janie [00:50:32]: One of them is even just how we staff our teams looks different than a traditional software engineering team, I'd say.Swyx [00:50:40]: Let's go.Clinician Scientists, Edge Cases, and Evals at ScaleJanie [00:50:41]: We have a bunch of folks with different roles who are clinicians and so we have this role called the clinician scientist and I heard one of our leaders refer to them as mutants recently. But they are people who've had clinical backgrounds, so MDs typically, who are also deeply technical, somewhere, on the spectrum of like a full stack engineer all the way to like extremely scrappy prompter. But having each of these people embedded within our teams instantly raises the bar for everything that we build because not only are they determining, is this product clinically useful but they're deeply embedded in our whole evals process. And so when we talk about LFDs, when we talk about what is our actual evaluation criteria, you don't want Chai or me creating what those are because we don't have clinical background. But is probably unique to Abridge but has been game changing. And when you think about where the puck is going, you have people build with clinical backgrounds who are technical and where AI tools are going, they just becomeJanie [00:51:53]: More and more, critical and like the killers of the team. And so that's one. And then the second is just the scale at which we do evals to catch that long tail up front before anything ever gets into production is something that we've pretty much like really started to fine-tune, both from a scale but when do we know we need to get several hundred versus several thousand offline responses, what helps us make that quick decision and make this less of an art and as much of a science as possible. But that's also been something we've had to tune over time.Swyx [00:52:27]: And you have partners who opted in to give you those evals.Janie [00:52:31]: So we work either internally or with third-party for offline evals and then we have customers who also agree to give us, whether it's like thumbs up, thumbs down to like choose this or that, a lot of data to get us to what is as close to fully confident as possible.Swyx [00:52:51]: The term that comes to mind isSwyx [00:52:53]: Like active learning on things where you're weak. I feel like it's a lost artSwyx [00:52:58]: Is a lot of the polish that comes into doing something like this.Janie [00:53:02]: Really.Chai [00:53:03]: Hundred percent.Lessons from Glean: Technical Foundations and AI App InfrastructureJacob [00:53:04]: Maybe, on a totally unrelated note, Chai, you had a very, storied run at Glean b
Is AI reinforcing or diluting your brand? Which brands do LLMs choose to surface and why? LLMs are actively shaping how brands are discovered, compared and chosen. They are becoming the new gatekeepers of growth. In this expert roundtable, Kantar leaders, from across disciplines and markets, discuss how LLMs are reshaping brand discovery.You'll leave with clarity on:1. New opportunities for growth in the AI era2. Practical guidance to support confident, informed next steps for your brand3. Data-led perspectives to shape what to focus on Win the LLMs' choice using signal intelligenceVisibility is not enough. Brands need signal intelligence to understand how AI assistants are reshaping consumer decisions. Win the LLMs' choice by strengthening the brand signals AI relies on. BrandDigital AI signals goes beyond short-term discoverability to show how LLMs shape long-term brand equity, grounded in Kantar's Meaningful, Different and Salient (MDS) framework.From visibility metrics to MDS-aligned signals, itreveals how brand predisposition is built or erodedacross AI assistants.Find out more: Kantar BrandDigital AI signals Hosted on Acast. See acast.com/privacy for more information.
This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Dr. Andrea Steely, an Assistant Professor of Cardiac Surgery in the Division of Cardiothoracic Surgery at the University of Utah Health, Salt Lake City, UT, USA, about aortic surgery and long-term patient follow-up. Chapters 00:00 Intro 01:43 New CTSNet Website 02:36 AATS 2026 09:15 EJCTS News 10:15 Video 1, Left Ventriculotomy 10:51 Video 2, 3-Vessel TECAB 12:24 Video 3, AV Disease in Young Patients 13:14 Andrea Steely, Aortic Surgery & Follow-Up 29:14 Upcoming Events They discussed the critical importance of educating both patients and surgeons about aortic disease, and the most effective strategies for follow-up care after aortic surgery. The conversation also covered testing genetic factors and stabilizing the aortic arch. They also explored reintervention and the importance of a multidisciplinary follow-up approach. Additionally, they addressed topics such as lung cancer screening, the training of non-MDs to evaluate screening charts, and the development of an aortic pathology sheet for each patient. In addition, Joel explores an underutilized approach for closing multiple apical ventricular septal defects, robotic-assisted three-vessel minimally invasive coronary artery bypass, and a presentation from Emile Bacha on the "Surgical Management of Aortic Valve Disease in Young Patients." Before closing, Joel highlights upcoming events in CT surgery. CTSNet Content Mentioned 1. Left Ventriculotomy: An Underutilized Approach for Closing Multiple Apical Ventricular Septal Defects 2. Robotic-Assisted Three-Vessel Minimally Invasive Coronary Artery Bypass 3. SCTS 2026 | Surgical Management of Aortic Valve Disease in Young Patients Other Items Mentioned 1. How to Navigate the New CTSNet Website 2. Career Center 3. CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Passione Triathlon n° 358Christian Melucciprotagonista della nuova puntata di Passione Triathlon, intervista condotta da Dario Daddo Nardone.In questa puntata speciale di Passione Triathlon, il Daddo ospita Cristian Melucci, per tutti "il Melux", reduce dall'incredibile esperienza della Marathon des Sables nel suo 40° anniversario. Cristian, nuotatore d'anima e triatleta abituato alle sfide estreme (Norseman, Icon), racconta come il deserto lo abbia profondamente cambiato. Un viaggio di 7 giorni in autosufficienza alimentare tra dune giganti, tempeste di sabbia e vesciche dolorose, dove la vera forza non è stata solo nei muscoli, ma nella "fratellanza della Tenda 28". Un'intervista emozionante sulla semplicità, sui limiti mentali e sulla bellezza di spogliarsi del superfluo per ritrovare l'essenziale.CAPITOLI00:00 - Introduzione: Cristian Melucci e l'esperienza che ti cambia01:25 - La logistica del deserto: da Marrakech al confine algerino03:10 - I numeri della 40ª edizione: 7 giorni e la tappa record da 100 km05:15 - La Tenda 28: sette fratelli e la condivisione dell'intimità07:45 - Il rito della partenza: la musica degli AC/DC nel deserto10:15 - MdS vs Triathlon Estremo: differenze di preparazione e fatica13:38 - Lo zaino: la sfida dell'autosufficienza e il peso dei grammi17:40 - Odori e igiene: quando puzzi come una "pecora incarognita"19:50 - Il risveglio nel bivacco: "Good Morning Bivouac!"23:10 - La sofferenza delle vesciche: gestire il dolore fisico e mentale24:45 - La notte sotto le stelle e l'alba sulle dune27:00 - Tappa 5: pioggia e tempesta di sabbia nel deserto29:40 - Viaggio interiore: pensare a chi non c'è più31:55 - Saluti alla Tenda 28: Davide, Gianluca, Alessandro, Andrea, Franco, Enrico, Giacomo34:00 - Regressione e sopravvivenza: tornare alle necessità primordiali37:15 - I 3 momenti più belli: la duna al 40%, l'arrivo della 100 km e i volti degli amici41:30 - Cosa mi ha donato il deserto: la semplicità43:10 - Obiettivi futuri: Cocodona 250 in Arizona e Ultra Trail45:00 - Perché lo faccio? L'esempio per mio figlio e la sfida "Behind the limit"PASSIONE TRIATHLON, segui le nuove puntate sul canale youtube @DaddoSport#daddocè #mondotriathlon #ioTRIamo ❤️________Video puntate Passione Triathlon: https://www.mondotriathlon.it/passioneSegui il Podcast di Passione Triathlon anche suSpotify: https://open.spotify.com/show/7FgsIqHtPVSMWmvDk3ygM1Spreaker: https://www.spreaker.com/show/triathlonAmazon Music: https://music.amazon.com/podcasts/f7e2e6f0-3473-4b18-b2d9-f6499078b9e0/mondo-triathlon-daddo-podcastApple Podcast: https://podcasts.apple.com/it/podcast/mondo-triathlon-daddo-podcast/id1226932686Trinews: Mondotriathlon.itFacebook: @mondotriathlonInstagram: @mondotriathlon________#triathlon #trilife #fczstyle#mondotriathlon #passionetriathlon#galadeltriathlon #triathlonshow #trivoluzione#daddosport #goveganDiventa un supporter di questo podcast: https://www.spreaker.com/podcast/mondo-triathlon-daddo-podcast--2275909/support.
Rick writes "I was on your show about two years ago regarding my investigations into the potential paranormal aspects of the Bigfoot phenomenon. I would like to update you on my efforts (Quantum Bridge Project) and the progress we've made to date. As you know, I used to be the State Director for the Virginia Chapter of the Mutual UFO Network and investigated numerous UFO sighting reports to include purported "abduction" cases. I transitioned to the paranormal realm because of the apparent similarities in certain cases. I've been with the Center for Paranormal Research and Investigations (CPRI) for the past twenty-four years and, within the past eight years, started conducting "cryptid" research for the same aforementioned reasons. I chose CPRI because of their philosophy and the way they approached the paranormal using the scientific method. The organization has MDs, PhDs in sociology, educators, nurses, chemists, current and former law enforcement officers, etc. CPRI is a Virginia 501(c) nonprofit, educational organization with a Board of Directors. I approached their Board with a written research proposal requesting that we investigate the "cryptid" phenomena in the same fashion they approach the paranormal; using certain specialized instrumentation and equipment like thermal imaging/ recording devises, remote data loggers designed to measure various EM/ radiological fields, and certain environmental conditions. My proposal involved locating a potentially credible cryptid investigator and working with them in their respected field research areas in order to capture supporting data during a sighting. This would not only validate that something is actually occurring, but to potentially explain certain aspects of the phenomenon. I've attached this particular proposal for your reference. One of my investigators located Harley Owens; a fairly new cryptid investigator in the East Tennessee area. Some of his sightings have been validated by other independent investigators, so I decided to work with him. His research area is near Cosby, TN, which is one of the areas the late Scott Carpenter used to investigate. Over the past two years, Ive independently investigated this area with Harley to further gauge his credibility before devoting CPRI resources to this geographical area. During that time, I've seen strange tree structures, heard screams, roars, and strange "barn owl" sounds, I have also seen those infamous" lights" that are seemingly associated with the Bigfoot phenomenon. On one occasion, I saw one of these "lights" at night on my thermal imager. It was moving intelligently through the forest. Interestingly enough, when I tried to see the light without the thermal, it wasn't visible. When I looked through the thermal, it would reappear, indicating it had some type of invisible heat source. Harley was next to me and wanted to see the light through the thermal. When he looked through it, he saw the light and, as it approached a dirt road, he said the light "transformed" into an upright being exhibiting a heat signature. It walked across the road and up an incline towards an adjacent knoll. I didn't see this; however, about one minute later, I heard a loud scream and an "owl' like vocal come from this same knoll. This scream was extremely loud and lasted about two to three seconds. It also sounded like some type of primate. It was immediately followed by an "owl" vocal, which didn't seem right. On another investigation in July of 2024, Harley and I were in his research area one night when we heard a loud, very intimidating roar (not scream) coming from another Ridgeline adjacent to a cemetery, which is the apparent focal point of the activity. This roar was so intimidating and loud, we were concerned for our safety. You could actually feel "rage" coming from whatever made it. I've never heard anything quite like it before, so we decided to pack everything up in order to make a quick exit if the situation called for it. We didn't stay too much longer before we left the area. As you probably know, these so called "orb" sightings are very common in both Bigfoot and paranormal cases, which leads me to some information you and your listeners may find very interesting. Back in 2003, CPRI investigated a case near Bedford, VA. This case involved a lady who lived on a farm in a double wide home. The lady reported seeing shadows, hearing voices and reported poltergeist type activity throughout the house. During the course of our investigation, she related an incident that occurred in the early 80s. She was getting ready for bed, had just turned off the bedroom lights when she saw three "orbs" hovering in a level, straight line at the foot of her bed. They appeared to be the size of a softball and each exhibited a different color; one was orange, one was light blue and the last was reddish They emitted light and then moved in unison (line formation) down her hallway and made a 90 degree left turn into her dinning room. She immediately went to the dinning room to see where they went and couldn't locate them. It was as if they just disappeared. The following morning, she went back into the dinning room and noticed three circular discolored/ burnt marks on her window screen. She believed these orbs went through the screen because they weren't there before, the window was left open and each mark was about the same size of these orbs. We asked her about the screen and, fortunately, she had rolled it up and kept it in her barn and forgot about it. We went to the barn and she pulled it out. The screen still had these three strange marks on it, so we asked if we could have it analyzed. She agreed, so we gave it to one of our members who happened to be a Radiochemist and worked for a federal lab in eastern Virginia. He's no longer with CPRI, so I'm not at liberty to divulge his name or where he worked without permission. He took the screen to his lab for analysis. A few weeks later, he sent us a report with his findings, which were intriguing. I've attached a document containing excerpts of his report to keep him and his employer's information confidential. According to the report, the discolored sections of the screen were highly irradiated. The areas were so irradiated we decided to ask the lady some health questions. Around the same time as the orb incident, she did experience bad flu symptoms, nausea, fever and general weakness, which lasted about a week or two. She thought it was just the flu, but did reveal additional information that brings doubt to that conclusion. A few years later, the had to have hip replacement surgery. After the surgery, the doctor asked if she had ever had radiation therapy. When she said no, the doctor said the bone structure of her hip was porous. It appeared to have been subjected to a type of radiation. Apparently she may have been exposed to a great deal of radiation that night. This is not to say that all orb phenomena contains radioactive properties, but it appears these lights did. In March of 2025, I assembled a team from CPRI and we (along with Harley) conducted a preliminary investigation of the Cosby site. The team consisted of Harley, myself, an archeologist, University Professor and another retired law enforcement officer. We did take some instrumentation with us. During the course of three days, we found several unusual tree structures, interviewed a resident in the area and conducted night surveillance. The primary location was the site of an old cemetery, which seems to be the focal point of the activity. We were able to witness unusual light activity in the cemetery. This took the form of small red points of moving light. Another larger red light was also seen depending in a straight line towards the same Ridgeline that the "roar" was heard a year earlier. Our archeologist witnessed a large, indistinct dark mass cross in front of him through the cemetery. He was wearing an Apple Smart Watch with embedded bio sensor at the time. He was able to pull the heart rate data from the watch and, at the exact time he witnessed this event. His heart rate jumped from 66 BPM to 124 BPM. On one occasion, our professor also witnessed a small green light hovering about thirty feet above the cemetery. These lights couldn't readily be explained. They didn't match the will-o-the-wisp (swamp methane gas ignition) phenomena because the weather was cool, it hadn't rained, low humidity and most of the colors seen were red instead of the signature faint blue-violet glow."
Cette semaine, replay du printemps avec Veesion et son CEO Thibault, invité en septembre dernier.
The FY 2027 SNF Proposed Rule may only be 40 pages long… but the implications for skilled nursing operators are massive.In this episode of Gravity Healthcare Hacks, Melissa Brown breaks down the biggest takeaways from the proposed rule and explains what SNF leaders should be paying attention to right now — including reimbursement changes, PDPM case mix concerns, therapy adjustments, quality reporting updates, and why CMS is signaling increased scrutiny around MDS coding and documentation.Melissa also walks through: The proposed 2.4% reimbursement increase — and why many operators feel it falls short CMS concerns around “case mix creep” under PDPM Proposed payment reductions to Speech, Nursing, and NTA Why therapy components may actually increase What operators should be advocating for before the June 1, 2026 comment deadline How future all-payer MDS reporting could reshape quality visibility The growing importance of Medicare Advantage quality outcomes Why now is the time to audit your MDS processes and documentation If you operate a SNF, manage reimbursement, oversee MDS, or lead clinical operations, this is an episode you do not want to miss.Read more and access additional insights from this episode here: https://gravityhealthcareconsulting.com/gravity-healthcare-hacks-podcast/fy-2027-snf-proposed-ruleNeed help auditing your MDS processes, PDPM accuracy, or reimbursement strategy?Visit Gravity Consulting or contact Melissa Brown and the Gravity team to learn how we help SNFs improve reimbursement accuracy, operational performance, and clinical outcomes.Connect with Gravity Consulting: • Website: https://gravityconsulting.com • Contact Melissa Brown: https://gravityhealthcareconsulting.com/schedule-a-consultation • LinkedIn: https://www.linkedin.com/company/gravityhealthcareconsultingThanks for listening to Gravity Healthcare Hacks. Be sure to subscribe, leave a review, and share this episode with another healthcare leader navigating the changing SNF landscape.Support the show
Dr. Deb Muth 0:03What are the answers to your child’s chronic allergies, ADHD, or autism?weren’t just in another prescription, but in restoring balance to their body chemistry. Today’s guest has spent nearly two decades uncovering those answers through integrative and biomedical medicine. That’s a mouthful, isn’t it?Helping children heal when nothing else seemed to work.This is the conversation about science, compassion, and changing the future of pediatric care.Welcome back to Let’s Talk Wellness Now. The show where we uncover the root causes of chronic illness, explore regenerative breakthroughs, and empower you with the practical tools to heal. I’m your host, Dr. Deb, your medical detective, and today’s episode is one every patient should hear.My guest is Dr. Anu Usman Singh, Medical Director of True Health Medical Center in Naperville, Illinois, and the owner of Pure Compounding Pharmacy.And for over 17 years, she has been pioneering evidence-based integrative interventions for children with ADD, autism, allergies, and complex gastrointestinal and metabolic disorders. She’s not only a practicing physician, she’s a researcher who’s investigated copper-zinc imbalances.metallonine dysfunction, biofilm-related infections, vitamin D in pregnancy, and hyperbaric oxygen therapy.Dr. Usman serves on the executive board of TACA, and is a faculty member at MAPS, training other practitioners in pediatric integrative care. So get ready for a conversation that will open your mind and heart to the possibilities of when medicine truly becomes holistic.If you guys can insert the ad in here, that’d be great.Well, welcome back. I’m so excited to have Dr. Usman with me today. I have known her for, oh my gosh, 15, 17 years, something like that. We’re aging ourselves. Anju 02:32Oh, yeah, when we were in our 20s, right? Dr. Deb Muth 02:35Yes, exactly. So, welcome back, and I am so excited for you to be here, because you have literally helped thousands of families over the years.But I’d love for you to share a little bit about your journey, kind of who you are, what drew you into exploring integrative and biomedical approaches for helping children and families. Anju 02:58I think my journey is similar to a lot of you out there, the audience. I mean, we’re looking to help our families, and our kids, and ourselves, and I was doing my residency at Cook County Hospital, downtown Chicago, in the 80s.And I thought, oh my goodness, if I could take care of the sickest patients, then I can take care of anybody. So I came from Indiana, and I went to Cook County, and my children, my eldest daughter, started having, severe allergies and asthma, really, really at a young age.And I went to, like, my residence, and I went to my attendings, and I said, this baby is wheezing. And they told me, babies don’t have asthma.And I said, she has all the symptoms of asthma. She has asthma. And I remember with, in her crib, I would just nebulize her, you know, and I was like, what is going on?And I figured out that she had a lot of food allergies, and I was nursing her, eating the foods that she was allergic to, and back then, in the 80s, you know, we didn’t have the internet, we didn’t have Whole Foods, and I just…being a doctor, and I didn’t even know what to do, and I felt so hopeless. And I thought, gosh, you know, I’m a doctor, I have these, like, skills, I have… people I can talk to, and I still feel so… it’s so difficult. And then this… my particular daughter, the oldest one, her name is Priya, and she developed severe, asthma, and I couldn’t figure it out. She was in junior high. Every time she would walk into the lunchroom, she would have a severe asthma attack.And I’ll be like, what’s going on? What’s going on? I kept her home over the weekend, she was better. I sent her back to school, she was bad again.And we figured it out that it was other people eating peanuts. Dr. Deb Muth 04:54Severe peanut allergy. Anju 04:56And I went to the school, and I said, she…can you, like, put her somewhere else? Can… they said, oh, no, that’s not fair to other kids and their food. And this was in the 90s. Dr. Deb Muth 05:10Yeah. Anju 05:10And so, I just…You know, my heart goes out to families who are struggling to find answers for their kids, and my daughter Priya, the one I told you about, she ended up passing away from a peanut allergy.And so, I’ve just… Dr. Deb Muth 05:26Yeah. Anju 05:27My heart goes out to parents and my own kids and their illnesses.And so I just started working with families, with kids, andIt just kind of grew from there. Dr. Deb Muth 05:40Yeah. Yeah. Yeah, and I think being a mom who went through that yourself, and…was seen but not heard, and turned away from the traditional medical community, you’re forced to start finding answers on your own. And we always feel like we’re on an island by ourselves in the medical world when we’re doing that. Anju 06:01Yeah, I, it was really hard when I found out, you know, about…Integrative medicine, and just different…ideas and approaches to diet and supplements, I thought, how come I wasn’t trained in any of this?And… Dr. Deb Muth 06:21So angry when I learned some of the things that I learned in the beginning. I was like, same thing, like, how did they not teach us this? And then I think, you know, it’s my fault, was I asleep, was I not paying attention, whatever. And then you just realize, like, there’s this whole part of the human body.That they just didn’t teach us. Anju 06:42Yeah, so then I… I, probably like you, we had to learn it on our own. There weren’t, like, classes or any way to learn this stuffAnd I just reached out. There’s a clinic that,I don’t know if you’ve heard of the Pfeiffer Treatment Center? Dr. Deb Muth 07:00No. Anju 07:01Do you know Carl Pfeiffer from the attendees.He has a clinic called the Pfeiffer Treatment Center in New Jersey. It was called the Princeton Brain Bio Center. Dr. Deb Muth 07:12And in the 70s, they did orthomolecular medicine for patients with ADD. Anju 07:18And schizophrenia. Dr. Deb Muth 07:20Mmm… Anju 07:21and depression.And they used to categorize them in 3 categories, and at the time, they called them histopenics, histidelics, and pyrolurics. Dr. Deb Muth 07:31Okay. Anju 07:32Histapenix were low histamine patients.Delix were high histamine patients, and pyrolurics were their own kind of category. We added another category of copper-zinc imbalances, and then we would categorize that population into high histamine, low histamine, pyrolurics, and copper-zinc.Now we talk about under-methylation, over-methylation. Sure. So, under-methylation is the, you know, the high histamine people, they can’t clear the histamine. And the over-methylators are, you know, what we call about low histamine now.And, and then pyrolurics and copper zinc. So…I lost my train of thought, but in the 80s, when I was going through this, in the 90s, I reached out to the Pfeiffer Treatment Center.He’s like, can I calm and just hang out and, like, see what you guys do? Because I need some answers.And I started working there and, started doing research on copper-zinc imbalances, and I did it in children with autism.And that’s how people started coming to me, and I kinda got, like. not famous, but I, you know, the word spread about, okay, we could talk about it, and Dr.Walsh was the, you know, PhD there that did a lot of the research, so we worked together for 8 years. Dr. Deb Muth 09:05Isn’t it crazy to think that we knew about histamine issues way back in the 70s? You know, I got the pleasure of being trained by, environmental medicine doctors. Dr. Wayne Konetsky and Glenn Toth taught me about environmental medicine, and what we called histamine issues that we call it today, mast cell, right? But when I was learning in the early 2000s, it was labeled as chemical sensitivity. And so it was just people that would react to everything, and we really didn’t know why, and they didn’t necessarily have this very specific allergic reaction, but we knew they were reacting, and we would try to treat them, to lower the histamine way back then. And it’s taken all these years, 25 years, to get to a point where we understand mast cell activation now, and histamine issues.And it’s really sad to me that it’s taking this long for us to identify things.And we’ve all got our journey, and I loved back in those days, too, because as I learned, I would call people up and say, hey, I just got a patient from you, and they told me this great story, and I have other people, can I come see what you were doing? And back then, everybody was very open. They were like, yes, please, come, learn. Now everybody’s like, oh, we can’t teach you, we can’t give you our secrets, but…Or pay me $20,000 to come learn with me. But back then, I mean, everybody was just… we were all in the same boat. We were all just trying to learn from each other. Anju 10:36Oh, yeah, oh yeah, and any bit of knowledge you got, you’re like… Dr. Deb Muth 10:41Yes. Anju 10:41God, you know, I learned this piece, and… Dr. Deb Muth 10:43Hmm? Anju 10:44We just kind of built from that. I keep thinking about back then, you know,the under-methylators, over-methylators, copper, zinc, and then I learned about metals.And then, as a physician, I was like, oh, okay, well, there’s mercury in vaccines, there’s aluminum in vaccines, and now I’m seeing these high levels. Dr. Deb Muth 11:04In my patients, now what happens? Anju 11:07And then we started, kind of, trying to get the word out about those things. Dr. Deb Muth 11:13Yeah. Anju 11:13And in 2000, a lot of the people that I knew put out a paper about, you know, mercury. Dr. Deb Muth 11:22And then… Anju 11:22And we all got on the Mercury bandwagon. Dr. Deb Muth 11:25Yes. Anju 11:26And did that for a while, and then we started learning about other things, like mitochondrial issues in chronically ill people, and these chronic infections, like Lyme disease, and so… and then now, you know, understanding mast cell activation, cell danger response. Dr. Deb Muth 11:44On endocrine, and adrenals, and hormones, and… Anju 11:48Yeah. Dr. Deb Muth 11:49biofilms. Anju 11:50Biofilms, I started talking about that in 2007. Dr. Deb Muth 11:54And so then… Anju 11:56It just… it just kind of keeps adding, and keeps adding, and keeps adding, and it’s like…Sometimes you think, how come I didn’t know about this back then? But I feel like it’s a process. Dr. Deb Muth 12:06It definitely is a process, and it’s amazing to seehow many people are researching different things, and they’re all, like, putting a piece of the puzzle together. And I think this is really important for our listeners to understand, is when you see a practitioner and they don’t have all the answers, this is why. It’s very complicated, it’s not black and white. And I’ve had patients over the years say to me, well, why didn’t you say this to me 6 months ago? And the truth of the matter was, I didn’t knowabout it 6 months ago. Like, all of this stuff is just… it’s evolving constantly, and when you’re a practitioner like Dr. Usman and myself, you are learning every single day. Our training has never stopped from the day we stepped into integrated medicine, and you just… you keep learning new things, and sharing new things, and talking to new people, and that’s what expands our knowledge base. Anju 12:57Yeah, the more I learn, the less I feel like I know. Dr. Deb Muth 13:01Yes, me too. Every time I go to a conference, I’m like, how did I not know this? How am I stupid? And I know we shouldn’t say that word and call ourselves that, but sometimes you feel like that. It’s like, how did I not know? Anju 13:14Or you’ll see a patient, and you’ll look at them, and you’re like, how come I didn’t realize this about this particular patient? Dr. Deb Muth 13:20Yes. Anju 13:21Yeah, they present differently, see things differently. I think that’s why it’s good to find a doctor that you trust and that you can work with, because it’s evolving. Dr. Deb Muth 13:31Yes. And, you know, we have those patients that they come, and I get those. I call myself, like, a tertiary care center. Anju 13:38You know, you get those patients that have been everywhere, and seen every doctor, and then they’re like, you’re my last hope, you’re gonna solve all my problems, and…I say to them. We’re a team, like, we’re gonna solve these together, but it takes time for me to unravel this puzzle. Dr. Deb Muth 13:54Excuse me? Anju 13:54And it… and sometimes, you know, there’s a few hits and misses along the way. Dr. Deb Muth 14:00Yup, but if. Anju 14:00If we keep at it, you know, we also say it’s a marathon, not a sprint. Yes. You know, if we keep at it, we can kind of figure it out together. Dr. Deb Muth 14:09Yeah, and a partnership, for sure, because without the feedback of the person you’re working with.understanding, like, we do this, and this happens to you, it’s very complicated as a practitioner to then be able to figure out, what do we do next? I see more and more clients these days, they come in and they just want to ask me within the first 5 minutes of, what am I changing? And I’m like, I have no clue yet. Like, you have to tell me what’s happened since the last time we did something, and then we have to look at labs, and we have to look at this, and we… it’s a synopsis.that we have to look at. You know, it’s not that black and white for us to be able to put the pieces together for them. Anju 14:47I think my most successful patients are the ones who are able to communicate with me.Their ups and downs. Yeah. And they also use their own intuition. Help me guide them. Dr. Deb Muth 15:06Yeah. Anju 15:07So, there are some people that they just hear, you do it, and you tell me.There are people who try to tell me everything. Dr. Deb Muth 15:15Okay. Anju 15:15Say, I want you to do this, do this, do this. Dr. Deb Muth 15:17Yeah, so I was like, okay. Anju 15:19I can do those things, but, you know, like. Dr. Deb Muth 15:21Yep. Anju 15:22think about blah blah. But, like, this… that collaboration.and, intuition. I kind of feel like even thoughI’ve trained allopathically as a traditional medical doctor. I feel like as I learn, I learn that being open and,Letting go of fear. Dr. Deb Muth 15:46Yeah. Anju 15:47And, not trying to jump on every, like, new thing, and being. Dr. Deb Muth 15:53consistent. Anju 15:54and diligent. really helps. Dr. Deb Muth 15:58It helps a ton. We see that, too, you know, the latest…Instagram influencer that’s talking about the latest topic, and all of a sudden, everybody sees themselves in there, and they must have that, but not realizing putting those connections together. It’s like when MTHFR came out, right? We were all so excited that this was going to be the detox gene.And then we learned so much more about genes, and now MTHFR is very popular again, and everyone’s talking about it, but they don’t understand how some of those other genetics fit together. And if you don’t understand that, we’ve all done it, we’ve all made people worse instead of better, sometimes when we’ve given too many methyl groups together, or this supplement without this support before we knew that there was another gene that we had to support for that.And I think it’s really important for people that are listening to us today talk about this, is don’t just jump on the bandwagon. Like, you really want to work with somebody seasoned who understands how all these pieces fit together. Anju 16:57Yeah, and I think that’s what individualized medicine is about.And there is no magic here, a magic bullet.I think that example of MTHFR is really good. Now, President Trump talked about Leukovorin. Dr. Deb Muth 17:14Yes. Anju 17:15in, and, you know, he’ll get up and say something like, leukovorin cures autism.And then the rest of us are like…Did you just say that? Dr. Deb Muth 17:26Yep, he did. Anju 17:30It’s folinic acid, it’s calcium folinic acid, it’s been around a long time. We’ve been using it for 20 years. Dr. Deb Muth 17:37Yeah. Anju 17:38But it does help a subset of people who potentially have what we call cerebral folate deficiency.And some of those people are misdiagnosed as autism. Dr. Deb Muth 17:50Yeah. Anju 17:51So, are you treating autism, or are you treating cerebral folate deficiency?same thing I could say about… I have a lot of cases of kids who recovered from autism.and severe ADHD using chelation type of. Dr. Deb Muth 18:06up. Anju 18:06Approaches, or detox approaches.again, did we treat their ADD and their autism, or did we treat their lead…Toxicity or lead burden, and their symptoms of those things got better. Dr. Deb Muth 18:20Yeah. Anju 18:20So, like, to put a big, like, a label like, oh, ADD on something, or autism on something, I think it does a disserviceTo the individuals, because it’s such a broad issue. Dr. Deb Muth 18:35It is, and I think the diagnosis has gotten to be much more popular these days.And yes, thank goodness we’re getting better diagnostics, but sometimes we’re getting over-diagnosis, or like you said, it may look like one thing, but it could be something else, but because it looks like autism, they’re going to get labeled with autism.And in some respects, that’s good, they can get more services that way, but sometimes we’re missing the actual picture of it. Can you talk a little bit about how autism is different than the cerebral folate deficiency? Anju 19:11Yeah, so there are some people that make an antibody to their folate receptor. Dr. Deb Muth 19:18Hmm. Anju 19:20So, to get folic acid into your cells, there’s a receptor on your cells. Dr. Deb Muth 19:25And then the folate has to bind to it, and then it lets it enter into the cells. Anju 19:30And there’s these receptors that allow folic acid to get into your brain.Now, you and I know when you put folate in your brain.On one end of the folate cycle, you help make more neurotransmitters. You’ll make something called BH4, and that’ll help make serotonin and dopamine, and then norepinephrine and epinephrine. So folate is really important for making your neurotransmitters, folate and B12.On the other end, it’s like, another cycle on the other end of folate is our methylation cycle.And methylation is so important for our RNA and our DNA, and making choline, phosphatoly choline, and making creatine for speech.And helping us with all the precursors for detoxification.So without folate in our brain, we can’t make our neurotransmitters efficiently, we can’t break them down efficiently, and we can’t detox our brain.Imagine what that will do to your brain. Dr. Deb Muth 20:36Yeah, Anju 20:37And you will see symptoms like speech delays, cognitive delays, processing issues, poor attention.All of those things. Excitation, anxiety.All of those, and so if the folate isn’t getting into the brain efficiently, then we’ll have all these symptoms, and we’ll end up with diagnoses like these. Dr. Deb Muth 20:59Yeah, so is there a way that people who are listening to this can request a test to see if they make this antibody to folate, or is it more of a diagnosis of exclusion? Anju 21:14That’s a great question. When I first started doing this, like, 20 years ago, there was, like, a university that was doing this.studies, and it was Dr. Quadros. He was the guy, and we would take samples and send them to his lab, and he would tell us about these blocking and binding. Dr. Deb Muth 21:30folate antibodies. Anju 21:32And if patients had positive blocking or binding folate antibodies, we would follow his protocol. And he’s done papers on patients with severe autism.Where he found these folate antibodies, and then did spinal taps on the kids, and they were associated with this cerebral folate deficiency. the cerebral… spinal fluid.And in his papers, he gave .5 to 2 milligrams per kilogram of calcium folinic acid, which is leukovorin. It’s a vitamin. And over a 6-month to a 12-month period.The majority of those patients improved drastically.Some of them regained speech, and some of them lost their autism diagnosis. Dr. Deb Muth 22:26Because they never truly had autism. Anju 22:29Well, they have autism symptoms, and that’s what autism is, but we call it autisms. Dr. Deb Muth 22:36Yeah. Anju 22:37And so now, like, we need the research to categorize these people. You know, what percentage of autism is cerebral folate deficiency? Yeah. What percentage of autism is, heavy metal. Dr. Deb Muth 22:51Bourbon. Anju 22:52And what percentage of autism is Clostridia overgrowth, or… Dr. Deb Muth 22:57Hmm. Anju 22:57microbiome… Dysfunction, and then there’s overlap. Dr. Deb Muth 23:01Right, yeah, Lyme and mold and viruses. Anju 23:04and infections, and you can see… Dr. Deb Muth 23:07injury from medications and things like that that happen, or birth traumas. Yeah, I mean, it’s not… it’s not as simple as what people think autism is.Why do you think that we’re seeing so much more autism today than when you and I were kids? We didn’t see this that often. I know environment has a lot to do with it, but do you have a couple of things that you suspect are contributing to the rise of autism these days? Anju 23:38Yeah, I mean, that’s a million dollar question. Dr. Deb Muth 23:40Right. Anju 23:41And, just because I work with children, you know it’s not just autism that’s epidemic, and yeah. Dr. Deb Muth 23:49You know that. I mean, it’s… it’s probably… if you add all the epidemics that are happening to children. Anju 23:54Autism still supersedes it.Now it’s 1 in 33s, 1 in 35 boys, I mean, it’s…children. It’s really sad. When I was in med school, it was 1 in 10,000. Dr. Deb Muth 24:10That’s crazy. Anju 24:11What’s causing it? I mean, obviously it’s multifactorial. Dr. Deb Muth 24:15Yeah, 80,000 chemicals in the environment that we never had before. Anju 24:20I, I, I, look, I’ve… 219 million. Dr. Deb Muth 24:26Oh my gosh. Anju 24:27I looked it up today. Dr. Deb Muth 24:29119 million different chemicals in the environment. Wow. Anju 24:33We don’t know how many of those are super toxic. Dr. Deb Muth 24:36Yeah, and we don’t know what they do together. Anju 24:38A lot of them were, like, before, like, grandfathered in and all of that.Yeah, it’s really crazy about the chemicals. So, chemicals… I kind of… feel like…you know, this burden of all this, it’s not just on our children, it’s on our mothers. Dr. Deb Muth 24:56Yes. Anju 24:56oh my gosh, the moms of these children that… And they don’t even realize it, you know, we’re just so happy to be pregnant and have a kid.So I think it really, really starts with that piece. Care, good prenatal care, yeah. Yeah, and not just what we think is prenatal care, taking your prenatal vitamins. Dr. Deb Muth 25:18Yes. Anju 25:19And going to your gynecologist, but what you and I think is prenatal care, you know, before you get pregnant, let’s detox, let’s clean up our diet, let’s get rid of those chemicals, let’s make sure we’re not in a moldy environment.You know, let’s do our due diligence, clean air, clean water, clean food, sunshine. When I did my residency at county, I don’t think I saw the sun for 3 years. Dr. Deb Muth 25:44How?Yeah. Anju 25:46it’s just that intense, and I was pregnant twice, and my eldest hasthe allergies and asthma. Number 2 is type 1 diabetes and mold sensitivities and allergies and asthma. Number 3 has severe chemical sensitivities, mast cell activation,Hormonal issues. Dr. Deb Muth 26:09Yeah. Anju 26:09And… number 4 is my… Golden, baby. Dr. Deb Muth 26:15And those three, you know, those years that you’re there, and you’re not seeing the sunlight, there’s vitamin D deficiency, and we don’t talk about vitamin D that much during pregnancy.I still am appalled that we’re giving folic acid these days during pregnancy instead of folate, but… Anju 26:36Folenic, or methylfolate? Dr. Deb Muth 26:38Yeah, nothing. So, when, when you,discovered vitamin D in pregnancy, and it’s linked to neurodevelopment outcomes. How did you stumble across that? Anju 26:50Well, in… when I started working on Copper Zinc, Dr. Walsh and I would go to the, like, DAN conferences.Yeah. At the time, and it was interesting, because DAM conferences were a collaboration between parents.And practitioners, and researchers. Dr. Deb Muth 27:10Very unique for. Anju 27:11That’s how that new IACC committee is. It’s a collaboration of parents. Dr. Deb Muth 27:17Hmm. Anju 27:18Practitioners, researchers, And individuals with autism. Dr. Deb Muth 27:25Yeah, so for those of you who are listening to us, it’s… we’re talking about the Interagency Autism Coordinating Committee that Bobby Kennedy just put together. It’s called IACC, and they are on a mission to try to do the research to figure out what’s causing autism. Anju 27:43Yeah, and not just causing it, like, these people have been living it, most of the people on that committee have been living it, and their whole lives, for some of them.And being able to bring forwardlike the question about vitamin D, we started seeing a lot of patients in Minnesota. Dr. Deb Muth 28:04Mmm. Anju 28:05who were from Somalia. Dr. Deb Muth 28:08Okay. Anju 28:09Who were… it was, like, 1 in 4 families with kids with autism.And the theory was that the vitamin D levels that they get in Somalia versus the vitamin D levels that the moms get in Minnesota. Dr. Deb Muth 28:27Hmm? Anju 28:28Affected the immune system. Dr. Deb Muth 28:31Yeah. Anju 28:32predispose them. So there’s a few papers on that. Dr. Deb Muth 28:36Yeah, that’s a… I mean, it would be a very significant difference, and when you’re thinking about genetically, like, what their culture, who they are as a species.was used to and adapted to with the sunlight and different things from a different region, geographical region, and then they moved to a new geographical region, that can take decades before the body adapts and readjusts.to that new environment. We don’t think about those things in…traditional medicine, and conventional medicine, as most people know it, but we do in functional medicine. Anju 29:14Yeah, so again, the clinicians were bringing this up, like, why am I seeing so many families? Dr. Deb Muth 29:18Yeah. Anju 29:18Then let me go to the… and then in the think tank, the vitamin D researcher said it’s vitamin D. Dr. Deb Muth 29:24Yeah. Anju 29:25And then they started researching it, and it was almost like a backwards… backwards. Dr. Deb Muth 29:31Thank you. You know, they didn’t first… Anju 29:33Think it. Dr. Deb Muth 29:34Think about it, yeah. Anju 29:35Until you start seeing… and that’s why I think that, like.clinicians like you and me, who are… I consider us on the front lines. We’re the front lines. We are seeing… we’re seeing this epidemic unfold. Dr. Deb Muth 29:46Yes. Anju 29:47front of our eyes, we’re seeing, like, the gut issues and the severe inflammation. We’re seeing the autoimmunity, and now they have to study it. Dr. Deb Muth 29:57Yeah. Anju 29:57They have to study this. They really, really, we really need, we really need protocols, we need tools, we need things that you and I have been figuring out anecdotally with our colleagues over the years, and, oh, how do we treat yeast? How do we treat Lyme? How do we treat metal burden?For this podcast today, I wanted to talk about low-level lead exposure, because for me.1 in 3 children have a lead level, above 5. 1 and 3. Dr. Deb Muth 30:31Yeah, that’s very high. Anju 30:33800 million children. Dr. Deb Muth 30:36And let’s clarify this, because the first thing people are going to think of is, what are they eating? They’re not eating lead paint to get this. That is not what’s happening here. They are getting lead from someplace else, and their bodies are not able to detox this. Anju 30:53And the reason I’m bringing this up is because when I was in residency at County in the 90s, I ran a… I worked at a lead clinic. Dr. Deb Muth 31:01And back then. Anju 31:03When we looked… we just diagnosed lead toxicity, the level was 60. Dr. Deb Muth 31:10Their level had to be 60 to diagnose them. Anju 31:13Correct. Dr. Deb Muth 31:13Oh my gosh. Anju 31:14And that’s when we would treat.And back then, there was a study, it’s called the TLC study, where they used DMSA, which is a drug to lower lead.And our goal was to get it from 60 to 20. Dr. Deb Muth 31:33And was the normal range the same back then as it is today? Anju 31:37The normal range has gone from 60 to 40 to 20 to 10 to 5 to 3.5.But you and I know I’m the normal range. Dr. Deb Muth 31:47Yes. Anju 31:47Zero. Dr. Deb Muth 31:48Zero. Anju 31:50So… so again, in my… in the lead clinic, we were given DMSA, and we got the lead from 60 to 20, and the number one thing was to get rid of the lead in the environment. Dr. Deb Muth 32:02Yeah. Anju 32:03But we haven’t evolved since then.Because in that study, It did not improve cognitive abilities. So if you think about what lead does, it causes attention issues, slow processing, it affects hearing, it can cause hyperactivity, it can cause impulsivity, it can cause aggression, it can cause constipation, it can cause hypotonia.So if you think about all these kids with ADD and autism, how many of them have low-level lead exposure from the lead pipes? In Chicago, it’s a big, a big problem. Dr. Deb Muth 32:37Yeah, Milwaukee. Anju 32:38Everybody thinks Flint, Michigan, but Flint, Michigan is not the only place. Dr. Deb Muth 32:42Right. Our infrastructure is so terrible, it has not been updated, and even though you might look in your house and you might see a white PVC or plastic pipe, what’s coming under the ground to the house in the cities is usually still lead. Anju 32:58Right. Right. Dr. Deb Muth 33:00Yeah. Anju 33:01So, I guess the point is, is that…the… the idea of, like, studying this. So, again, they study this, and they say, well, we’re not going to treat low-level lead exposure because it doesn’t improve their cognition.But did they really treat it? Dr. Deb Muth 33:18Right. We got it from 60… we got it from 60 to 20. Right. But when I know, where is the lead hiding? Anju 33:24So high. Look at the bones, it’s gonna be coming out. It’s gonna be coming out, especially during puberty. What happens to some of our kids during puberty? They just go a little wonky. Comes out again during menopause. Dr. Deb Muth 33:38Yes. Anju 33:39I don’t know, male menopause, too. Like, we’re all losing bone mass then, and our lead is coming out, our blood pressure goes up. So, again, these are some of the areas that I think, like, really need some… hard… looks. Dr. Deb Muth 33:53Right, yeah. So, what are you hopeful about this committee? Like, are you hopeful that this committee is going to be able to research some of these big things, and we’re really going to be able to find answers around some of the functional things and the biochemical things that we see, you and I know happen in the body, that might give some standardization and education to practitioners in the future. Anju 34:23Well, I think this committee understands the scope of the issues.And they’re coming from different perspectives, like I mentioned, research. Dr. Deb Muth 34:33Yeah. Anju 34:35really highly qualified MDs. MDs like you and me, who have been on the front lines. moms. Dr. Deb Muth 34:43Yeah. Anju 34:44dads, patience, And so, the strategy would be to get, again, their input, and then…get the places… people in places to do their research. And even make some guidelines and some, like, you know, thoughts about what we want to put out there. Dr. Deb Muth 35:05Yeah. Anju 35:05You know, how do we want to strategize for… Dr. Deb Muth 35:08Prevention. Anju 35:10Like, the pre-pregnancy thing. Dr. Deb Muth 35:12Yeah, I’m really hopeful that this doesn’t become a… political football,And it doesn’t get taken away if the administration changes or whatever, because people need to understand that this kind of researchthis is going to take decades for people to do. Granted, we have AI, and AI can help a little bit and get some things quicker.But trying to figure out all of these nuances to why the body does what it does is not gonna be, like, next week we’re gonna find out that this was the single cause, and I know a lot of people, they’re afraid of the vaccines, and that’s gonna be the sole answer.And that has a piece of it, but it is just a small piece of it for some people larger, but at the end of the day, that’s not what this is about. This isn’t about just labeling one thing that is the cause of autism, because it is not one thing. It is so multifactorial. Anju 36:09And I think that whole cause, I know,A lot of money has gone into. Dr. Deb Muth 36:16Yeah. Anju 36:16looking at that. They’re looking for the gene, right? The gene that causes it, and… Dr. Deb Muth 36:23answer. Anju 36:24They have not… they’ve spent millions of dollars looking for this.And it’s not gonna pan out. It’s not. Dr. Deb Muth 36:33I’m not. Anju 36:34pan out. It’s more complex, like we’re talking about. Dr. Deb Muth 36:38Yeah. Anju 36:38And, I do think that sometimes, you know.Even though, like, politically, it seems like it’s a political topic, but it has zero to do with politics. Dr. Deb Muth 36:52Yeah, exactly. This is our children. This is the future of our country, the world. I mean, America’s not the only place that has kids with autism. I mean, this is the future of humanity. If we don’t figure out what’s injuring our children, there will not be a humanity that you and I have seen. It will be different. And, and this is important, we owe it to the future of our generations, we owe it to our children to figure this out and clean up our environment, and make it safe for everybody. Anju 37:24Yeah. Clean up our air, clean up our water, clean up our food… Dr. Deb Muth 37:29Yeah. Anju 37:30You know, our lifestyle a little bit, but… Dr. Deb Muth 37:32hoodie? Anju 37:33It’s… it’s… it’s everywhere. I travel all over. Dr. Deb Muth 37:36Bye. Anju 37:37Consult with doctors in different countries, in Italy, in India, Bulgaria, Romania… Dr. Deb Muth 37:46Yeah. And. Anju 37:48we’re going to Australia for med maps to treat doctors in, in April. And it’s a problem everywhere. Dr. Deb Muth 38:00Yeah. Anju 38:01really big problem, and it affects everybody. Even if you don’t have a child with autism or a grandchild with autism, it’s still affecting families, becauseI kind of think of ADD as being on the spectrum, in the sense thatI think the same kind of positive issues that lead to the autism are causing the ADD, just to… you know, your genetics are playing a little bit of a different role, whatever… whatever protection you have is a bit more there, but we’re seeing kind of, like, similar metabolic… issues in our ADD population. Dr. Deb Muth 38:43Yeah. Yeah, there’s so many different levels of this, and it does affect everyone. Like, I think everybody knows… a family or someone in their classroom or their school or their community that’s affected by, definitely, ADHD, Asperger’s, autism, all of those things, whether you’re high functioning or not functioning or whatever.everything is affected. The school system is affected, your social circles are affected, your families are affected.the healthcare is affected. I mean, everything is affected. We owe it to our families and our communities to help people try to figure this out. Anju 39:22Yeah, and I think even if it’s not ADD, or ADHD, or autism we’re talking about, or even OCD, anxiety, depression, I mean, you know… Dr. Deb Muth 39:33Candace? Anju 39:34Any kind of chronic illness that people are dealing with has underpinnings of these kinds of, you know, issues. Dr. Deb Muth 39:43Yeah. Anju 39:44Any autoimmune issue? That’s great. Dr. Deb Muth 39:48inflammatory syndrome that we’re seeing these days, I mean, the pants-pandas piece, the biofilms, the strep, I mean, our environment is just so laden with infections and biofilms, and And, you know, when you and I first were learning about this, we never thought anything could cross the blood-brain barrier, right? It was pristine, there’s nothing getting in there unless you could drive it in there, and now we know that’s different, and now we’re seeing bugs in the brains of people who have had Alzheimer’s disease and dementia because they’ve donated their brains for research, and we can see what’s crossing the blood-brain barrier, and it’s really scary. Anju 40:24Yeah, yeah. There’s a lot of things we don’t know. Remember when we just found out that they… the brain had a lymphatic system? Dr. Deb Muth 40:33And that wasn’t About, what, 5, 6 years ago? 7 years ago, maybe? Yeah, not that long ago. Anju 40:38You’d be like, why wouldn’t the brain have a lymphatic system? Dr. Deb Muth 40:41Yeah! Yep. Anju 40:44Yeah, so things get in and out. Dr. Deb Muth 40:46They, they definitely. Anju 40:47You know, they get in easier than they get out, I think. Dr. Deb Muth 40:50I agree, I think they do, for sure, for sure. You know, when you’re talking to a family who’s undergoing issues like this, what’s the role, do you feel, in personalized nutrition to help them make things better? Anju 41:10I kind of go through, like, a little bit of a start here, start there, and then do this. I always start, number one, I say, okay, you gotta clean up your environment, because… We gotta do that. Dr. Deb Muth 41:24But that’s a… Anju 41:24process. And then number 2 for me is cleaning up the diet. And then, when you say personalized nutrition. To me, figuring out what is a good diet for the individual. Dr. Deb Muth 41:38Makes it a little bit difficult. Yeah. Anju 41:41I mean, there is, like, healthy eating concepts, where, you know, eat upside-down food pyramid kind of concept, I guess, is the new one, but whole foods, whole grains, organic as much as possible, especially for animal products, good fats, avoiding, you know, hydrogenated oils, and those seed oils, and… Just some basics, and then individualizing for my patients, a lot of people with any kind of autoimmune condition, and we kind of put autism in that neuroimmune, autoimmune, inflammatory That, gluten-free, dairy-free, and sugar-free kind of go there, like, as a given. If there’s a lot of gut issues, a lot of our folks have oxalate issues. And then we have to sometimes do low or limited oxalate diets. Many of my patients can’t convert glutamate to GABA efficiently. Dr. Deb Muth 42:44Yeah. So, high glutamates associated with OCD, and kind of looping or repetitive behaviors. Anju 42:51So, low-glutamate diets. And then some of my patients have SIBO, and then we do the low FODMAPs diet, and then some of my patients have messel, and we’ll do the fail-safe kind of concept with the fail-safe diet, so nutrition can get a little bit complex for certain people, but there are some basics, and then there are some, like, more of… Individual, kind of, diet approaches. And then there’s supplementation. There’s some things that I call foundational. For me, certain things most people need that have a chronic illness. Dr. Deb Muth 43:26Yeah. Anju 43:26Vitamin D3 is one of those. Omega-3s are another one for most. And then, because I did a lot of research on copper, zinc, I think 3 mineral… 4 minerals. I feel like people underdo minerals. They’re so important. Every single enzyme has a mineral cofactor, so… zinc is really important for my population with autism and ADD. 99% of them had high copper or low zinc in. Dr. Deb Muth 43:58Wow. Anju 43:59Over 400 patients that we tested. Dr. Deb Muth 44:01Wow. Anju 44:03And, magnesium.So, zinc, magnesium, and then the other two minerals I really like are selenium for glutathione. and molybdenum for sulfation, and glycolysis. So… So those are kind of my foundational pieces, and then I like to work on the gut next. So, from a nutritional perspective, prebiotics are my new favorite. Dr. Deb Muth 44:29Yeah, we go in and out with prebiotics, probiotics, postbiotics. Anju 44:34Yeah, exactly, symbiotics. Dr. Deb Muth 44:36Yes, exactly, exactly. Anju 44:38demos, and… Dr. Deb Muth 44:40Yeah. Anju 44:40So yeah, biofilm busting, and all of that, so… And then I go into my other nitty-gritty stuff, like you probably do. Dr. Deb Muth 44:47individualized, right? So, you created, True Healing Nature, a supplement line, a supplement company, correct? Anju 44:56Yeah, True Hing Naturals. Dr. Deb Muth 44:58Truly Naturals, okay. Anju 44:59True, he is hard. Dr. Deb Muth 45:01Oats! Anju 45:01True! Dr. Deb Muth 45:01Healing natural. Got it, sorry about that. Tell us a little bit about what made you decide to create a supplement company. Was it because you couldn’t find formulations that you wanted? Couldn’t find clean products? That’s a big problem for people, for sure. Anju 45:19Yeah, a little bit of both. I told you that my kids were really sensitive, they had a lot. Dr. Deb Muth 45:23I know. Anju 45:24And when I would even try to give them things like ibuprofen. Dr. Deb Muth 45:28or Benadryl. Anju 45:30For allergies, they couldn’t tolerate the products that were over-the-counter. Dr. Deb Muth 45:35Yeah. Anju 45:35So, in 2007, I opened a compounding pharmacy so I could make things clean for them. Dr. Deb Muth 45:42Yeah. Anju 45:43And I thought it was so valuable. And so then I started seeing, like, certain issues with my patient population, for instance, say, mitochondrial issues. So, I would compound a mito cocktail. in my pharmacy. And then I had True Healing Naturals manufacture it, so I didn’t have to have patients get it compounded. Dr. Deb Muth 46:08Got it. Anju 46:09So that particular product’s called Mito Rescue. Okay. But then, I started… I do a lot of oats testing. Organic acid urine tests. Dr. Deb Muth 46:19Yeah. Anju 46:20But there’s, like, a marker on there for, oxalates, and I saw a lot of patients with oxalates, and oxalates inhibit some… an enzyme called, pyruvate decarboxylase. And that basically means you can’t take your carbs and turn them into energy. Dr. Deb Muth 46:38Okay. Anju 46:39So, if I saw this pattern with high oxalates and high pyruvic acid, I knew that that enzyme wasn’t working very well, and that enzyme is B1, molybdenum, and biotin dependent. So, I started compounding doses of that. And then I turned that into a product called Motor Connect, because high doses of biotin help with connectivity in the cerebellum. Dr. Deb Muth 47:08Got it. So, I did come… kind of start with the compounding pharmacy, try it, use it, and then turn it into. Anju 47:17products, and I have one for copper-zinc imbalances called True Minerals. Dr. Deb Muth 47:21Yeah, to fix the problems that were not commercially available. Could you talk a little bit for people who don’t understand what a compounding pharmacy is? Anju 47:32So, when you guys go to a pharmacy, you, you know, you send a prescription, and it’s already, it’s manufactured, and you get it. Well, a compounding pharmacy actually makes that for you. So they get the raw ingredients, and then they make that prescription. So it’s still prescription-based. But, for instance, say, I want Nystatin. And I go to Walgreens or CVS, and the nystatin there is a liquid, and it has yellow dyes and sugar. Dr. Deb Muth 48:02Yep. Or it’s a title, and it’s red. Anju 48:04or it’s bread, and a tablet, and I, like, oh, I want to treat the yeast, but I don’t want to use this. So I sent my nystatin prescription to a compounding pharmacy, and it’s Nystatin. That’s what you got. Yep. Dr. Deb Muth 48:17disappear. Anju 48:18So, pure compounding pharmacy, it’s pure, it’s pure stuff. Especially for our mast cell people. They’re so sensitive, and, you know, my kids are all mast cell, and so I just find that excipients, some people will say, oh, this doesn’t work, and I said, it’s probably the excipient that’s stimulating your mast cell activation. So, yeah. So, compounding pharmacies, You know, with all the big, kind of. conglomerates and big companies, they’ve become… they used to be, like, mom-and-pop kind of places. And my pharmacy is like that. It’s just… it’s… it’s a few of us, and we… we do it, and it’s nothing big or fancy, but we get the job done. So, we compound things like methylcobalamin injections, hydroxycobalamin, low-dose naltrexone. Different things for chelation. So, it’s nice. I love having it. Dr. Deb Muth 49:11Yeah, the compounding pharmacies really have made a huge difference for people who are sensitive. You know, so many ingredients are contaminated with corn and gluten and soy and dairy and all the big things that we want to stay away from, especially if we’re trying to treat the immune system. And even if the manufacturer says that’s not in our product. it’s contaminated, usually, because they’re usually preparing it in a facility that has those things floating around. Right. And for people who are really sensitive, that’s going to create some issues. Anju 49:45Yeah, people who are sensitive are sensitive to parts per trillion. Dr. Deb Muth 49:48Yeah. Anju 49:49I found that with my daughter with chemical sensitivity. You don’t have to see it, or you don’t have to smell it, but they could react to it. Dr. Deb Muth 49:55Yeah. And, a lot of these, like. Anju 49:58These different, substances, for instance, like enzymes, even the natural enzymes. Dr. Deb Muth 50:03They’re cultured in Aspergillus. Anju 50:07And so they’re extracted from mold. Dr. Deb Muth 50:10Yeah. Anju 50:11And so the really mold-sensitive people will maybe take a digestive enzyme, and they’ll have a reaction, and they’ll not understand why. Yeah. But it’s not because of the enzyme, it’s because of where it’s coming from. Dr. Deb Muth 50:22Yeah, where it’s cultured from. And if you have mold toxicity and mold sensitivity, and we’re looking at your mold test, wondering why are you getting a hit while we’re trying to clear it out, sometimes we forget that those products, and a variety of products that we used are cultured from molds. Yeah. Anju 50:40Yeah, yeah. It’s hard for the laypeople to understand all. Dr. Deb Muth 50:45You know. Anju 50:45of these pieces, but I think that… It used to be, like, the insurance companies would cover prescriptions from compounding pharmacies, but over the years, the lobbying and all of that has gotten so intense where, you know, a lot of that ends up out of pocket, but it’s really… it doesn’t really get that much more expensive than a copay would be. Dr. Deb Muth 51:05Right, right. Anju 51:06People just don’t know about it, yeah. Dr. Deb Muth 51:08Yeah, absolutely. So, you’ve been doing this now for more than 17 years, and you’ve made some remarkable progress with your patients. Can you share some success stories that still inspire you to do what you do every day? Anju 51:27I don’t know about you, but, like, when you first start, I think, God puts you… God puts all those really gray cases in front of you, because you’re like, whoa! Dr. Deb Muth 51:37Yes, and maybe… Anju 51:38I gave this patient methylcobalamin, and they started talking. Yeah. So methyl B12 back in the day was huge. you know, Dr. Nebrander’s protocol, and we would use that, and we would get speech, and… I mean, I’ve… it’s just… there’s hundreds of cases. There’s hundreds of cases, and same with Leukovorin now. Not for everybody, but when it really works, it’s really, really decent. Dr. Deb Muth 52:07Yeah, and worth a try, you know, if… if we suspect that’s what’s going on, these things are worth a try, because sometimes you just never know what’s going to be the key that unlocks the answer for them. Anju 52:19Yeah, but I think, you know, like, I can say… chelation, or… you know, I can, like, throw out a bunch of stuff. Dr. Deb Muth 52:26Okay. Anju 52:27In terms of, like, I’ve… I… I have those families, and I have those kids who are just… they’re just amazing, and they’re in college, and having jobs, and having kids, and… Dr. Deb Muth 52:38Yeah. Anju 52:38you know, all of that, but I think, you know, the ones that really strike me are the ones that I have to work really hard to get. Dr. Deb Muth 52:44And then we’. Anju 52:45they go, it’s not like, oh, I just did the diet, I’m cured, or I did this, and I’m better, or… Right. And I have those cases where the parents come to me and they say, I never thought my kid would Be going to college. And I never thought we would be here. So, those are the ones that really, like, when I get the little notes, or the, like, the college or the high school graduation pictures, and they… and some of them, you know, you lose touch with because they don’t need me anymore. Dr. Deb Muth 53:19Yeah. Anju 53:20And then you hear about it later. And then, I think the ones that don’t get better are the ones that, like, sit with me the most They just sit with me, and we’ve had this population of children with severe apraxia. So, apraxia is a motor planning issue, but if you saw these patients, you would think that they were… mentally deficient. Dr. Deb Muth 53:44Hmm. Anju 53:45Because they can’t talk. Dr. Deb Muth 53:46Yeah. Anju 53:47They’re the classic person that you would see that looks autistic. You know, running around, excited, verbal stimming, no speech. Dr. Deb Muth 53:57Hmm. Anju 53:58And that group of patients are incredibly Brilliant. And we are just finding out about how smart they are. There’s a book called Underestimated by J.B. Hanley and his son Jamie. JV has all the resources in the world. He used to put those ads in the New York Times about autism and vaccines. He could take his kid anywhere and do any treatment, and still, we… Blocked. Locked. Couldn’t get through. Couldn’t get through. And they started, spelling. To communicate, and this speller’s method, and it just opened a door. And it opened a door for so many of my patients who are metabolically challenged, so we do help them metabolically. Getting that ability to communicate. Some of them never got high school diplomas, and they went back to get their high school diplomas so they could go to college. Dr. Deb Muth 54:56Oh, wow, that’s amazing stories. Anju 54:59Yeah, and Elizabeth Bonker is one of those spellers, and she… she was a valedictorian in her high school, college. And she did a valedictorian speech that went. Viral, and she’s one of the people on that committee. Dr. Deb Muth 55:13That’s awesome. Anju 55:14He’s non-speaking. She… she can’t not speak. Dr. Deb Muth 55:20Wow. Anju 55:21But they asked her to be on this committee. Dr. Deb Muth 55:24That’s fantastic. Anju 55:26Huge. Dr. Deb Muth 55:27That’s huge. It is huge. There’s a way she can communicate, she just can’t verbalize the way you and I verbalize. Anju 55:34She’s brilliant. I mean, people on that committee, the, the individuals with autism on that committee, I know they’re brilliant people. Wow. But if you… if… If people saw them, they wouldn’t see that. Dr. Deb Muth 55:47Right. Anju 55:47So, I guess, for me, it’s like seeing the brilliance, seeing the competence in individuals, and as a practitioner, just trying to optimize it. But I know, like, the neurodiversity people say, okay, you know. We’re fine, and it’s like, yes, you are fine, you’re fine, and it’s okay. Whatever it is, it’s okay. But if you’re struggling metabolically, and we can help you feel better. What’s… what’s the harm in that? Dr. Deb Muth 56:13Right, let’s do that. Yeah. So you’re also part of something called MAPS, and you’re educating doctors worldwide. Tell us a little bit about MAPS, and how do you see the integrative pediatrics evolving in the next decade as a result of what we’re learning today? Anju 56:36I think we’re at a crossroads, and Maps is kind of in the middle of that crossroads. It used to be called Dan. Dr. Deb Muth 56:47Okay. Anju 56:47Autism Now. Dr. Deb Muth 56:48Yeah. Anju 56:49And then they kind of dissolved Dan and turned it into MedMaps. And MedMaps is Medical Academy for Pediatrics and Special Needs. So it’s not just special needs, it’s pediatrics. as well.So it’s kind of like the functional medicine for peds. And our goal is to train an army of clinicians to be the frontline. And how medicine should be, and how people should be trained. We should train them to do these types of things from the beginning. Because now it’s backwards. Dr. Deb Muth 57:28Right. Anju 57:30they come see us when nobody else can help them. But, so, we have some good leadership, and then… We are just trying to get people trained so that they understand that this is the future. Dr. Deb Muth 57:50If there’s a practitioner that’s listening to this, how do they get involved in MAPS? Anju 57:55They could come to a conference. Dr. Deb Muth 57:57Okay. Anju 57:58And the website is medmaps.org. And there’s 2 conferences a year. And we have scholarships, and we want people to come, so contact You know, the executive director, and… We just want people to come, share… their experiences, learn about functional medicine, it’s evidence-based, we try to… it’s really scientific, you know, we talk a lot of science. Dr. Deb Muth 58:25Oh yeah, a lot of science. Anju 58:26We talk a lot of science, and and so hopefully we can move all of this forward. Baster. Dr. Deb Muth 58:35I think the greatest thing, when you get into the functional medicine integrative space like this, and MAPS, and some of the other environmental academies and things like that. A lot of people might think it’s not science-based, and I’m always amazed at how much science we have, and it’s right, it’s all the things that you and I learned in biochem class, and chem class, and organic chem, and we were like, oh, let’s just learn this to be done with it. And then you get back, and you start doing integrated medicine, and you realize, like, all of that biochemistry stuff is what we needed to truly understand to fix people these These days, and you go back and you have to learn that in an intense version of it. Anju 59:18I felt like I finally understood the Krebs cycle, when I learned how it made metabolic stents, instead of just memorizing these cycles for… For the… Dr. Deb Muth 59:30Right? Like, they, like. Anju 59:32They just make sense to me. Dr. Deb Muth 59:34Yeah. Anju 59:35And I think that’s so important to understand, that all of this has science behind it, and it’s there, and the research is there. Dr. Deb Muth 59:46It’s just us having to learn how to utilize it, and recognize that not every person is going to be straightforward, and what we do for one might not work for another. There’s… It’s not as easy as prescribing a prescription and letting the person walk out the door in 10 minutes. That’s not what this is about at all. Anju 01:00:05No, and at MedMaps as well, they have a call for abstracts, and so we’re always looking for research, experience, so if any of the clinicians out there have, you know, things they want to share. then send an abstract to Maps. What a great blonde. I think, one of my doctor friends is doing an abstract on research that was done on sensory qigong massage. Dr. Deb Muth 01:00:34Oh. Anju 01:00:34And it helped with speech, and the theory was that, we were all thinking of the sensory system in the brain, the sensory system. In the periphery being affected neurologically, and how to turn that back on. So, it was… it’s… Dr. Deb Muth 01:00:51That’s neat. Anju 01:00:51Again, with the research, and with the science behind it, and with, like, clinical trials, and all of that. Dr. Deb Muth 01:00:58That’s awesome, I love that.For parents that are just starting in this journey, what would you recommend be their first one or two steps? Anju 01:01:10Educate, educate, educate? How do you get educated? I do think that, TakaNow.org is a good place for, like, a biomedical approach, or this functional approach for autism. It’s the Autism Community in Action. MedMaps is doing a parent conference in March. Dr. Deb Muth 01:01:31Oh, awesome. They usually do that around, Memorial Day, right? Anju 01:01:36They’ll do it around Labor Day in September. Dr. Deb Muth01:01:40Labor Day in September, okay. Anju 01:01:42Yeah, and then mid-March. Dr. Deb Muth 01:01:44Okay. Anju 01:01:45Yeah. And they hadn’t done a parent conference before, but we had parents that wanted to come to the conferences, and it was just for clinicians before. Dr. Deb Muth 01:01:54Got it. Is it Autism One that does theirs around Memorial Day? Anju 01:01:59Oh yeah, they don’t exist anymore. Dr. Deb Muth 01:02:01Don’t, really. Anju 01:02:03conferences. There was. Dr. Deb Muth 01:02:06NAA, the National Autism Association. Anju 01:02:09They don’t do a lot of parent conferences in functional medicine either, so there’s a few left. Documenting Hope. That’s another really nice one. Oh, that’s great. Dr. Deb Muth 01:02:21So, what last words do you want to leave with our listeners? Anju 01:02:29You know, that’s… people always ask that at the end of these… I, I do feel that, Listen to your heart, you know, follow your intuition. Dr. Deb Muth 01:02:40I’ll let that guide you. Anju 01:02:42There’s a lot of information, sometimes it gets to be too much information. It’s hard to process everything, try not to make impulsive decisions about things. And… If you have a child with special needs, or if you have a grandchild with, issues. Presume competence. There’s a lot there. Dr. Deb Muth 01:03:04Yeah. Anju 01:03:05Especially some of these kids with behavior issues. I don’t know how many patients of mine are… Put on psychotropic meds. Metabolic issues, and, you know… It’s like, a lot of them have pain, like headache, abdominal pain, and inflammation, and they’re treating them with psych meds. Dr. Deb Muth 01:03:25Yeah. That’s sad, isn’t it? Anju 01:03:28I think, you know, try to look for the underlying cause. Not just band-aid things. Dr. Deb Muth 01:03:34Where can listeners, learn more about your work and what you do? Anju 01:03:40Oh, that’s tough. I don’t have a book. One of these days. Dr. Deb Muth 01:03:48Yes! Anju 01:03:49Yes, one of these days. I think, you know, med maps, we have a… if they’re clinicians. Dr. Deb Muth 01:03:55Hmm? Anju 01:03:56I have lectured a lot. For, for, communities like Taka, so there’s just a lot of… lectures that I’ve given online. Dr. Deb Muth 01:04:09Awesome. Well, thank you for taking your time with us today. It’s been a great conversation with you. Anju 01:04:15Thank you so much for inviting me, Debra. I’m honored to be here, and thank you for doing the work that you do to put Put this out there for people, because it’s really important information. Dr. Deb Muth 01:04:27Thank you. Thank you for joining me today on Let’s Talk Wellness Now. Today’s discussion with Dr. Usman reminds us that there’s always more we can do. We can look deeper into biology, environment, and lifestyle. to heal the next generation. If this episode inspired you, please share it with a parent or a practitioner who believes every child deserves a chance to thrive. And to learn more about Dr. Usman, you can visit TrueHealthMedical.com or TrueHealingnaturals.com. And if you’re ready to explore your own root cause healing, visit us at Serenityhealthcarecenter.com. You can also follow me on Instagram, and don’t forget to subscribe so you never miss an episode of Let’s Talk Wellness now. Until next time. I’m Dr. Deb, reminding you to nurture your body, mind, and spirit. Be well, and I’ll see you soon.The post Episode 262 – The Root Cause of ADHD & Autism: Beyond the Diagnosis with Dr. Anju Usman Singh first appeared on Let's Talk Wellness Now.
Marathon des Sables with Chris Timms Endurance Asia Chris Timms returns to the Endurance Asia Podcast fresh from Marathon des Sables, the legendary multi-stage race across the Sahara.This episode breaks down the reality of MDS — from the race format and self-supported setup to the physical and mental demands of racing across multiple days in extreme conditions.Chris shares how he trained in Singapore, how he approached pacing and fueling, what surprised him most, and what he would change if he did it again. The conversation also dives into the emotional side of endurance — including racing with grief, being disconnected from family, and what the desert teaches you.Beyond performance, this is a story about community, resilience, and why stage racing is a completely different challenge.Timestamps 01:15 Intro and Chris returns from the desert 02:35 Why Marathon des Sables had always been on the list 06:43 MDS explained: stages, format, and self-supported racing 11:20 The field, the stories, and DNF reality 13:10 Training for MDS in Singapore 17:45 Gear choices: shoes, pack, and foot care 23:20 Nutrition strategy and calorie planning 26:07 Sleep, recovery, and life in camp 31:22 Pacing the race and lessons learned 36:57 Race result and finishing top 30 38:35 Camp life and learning from elite runners 41:54 Finish line energy and community 43:49 Bag weight, comforts, and mistakes 45:30 Racing with grief and mental strength 47:18 Time away from family and isolation 49:34 Why stage racing is uniquely hard 51:46 What's next after MDSFollow / listen https://www.enduranceasia.com/ https://podcasts.apple.com/gb/podcast/the-endurance-asia-podcast/id1459460675 https://open.spotify.com/show/23YnHpmjPgyGiHLfgkiOAk https://soundcloud.com/enduranceasia https://www.youtube.com/channel/UCUHv2YWma06vKwlzs53WZ5g/videos https://www.instagram.com/enduranceasia https://www.facebook.com/enduranceasiapod https://twitter.com/enduranceasia_ https://www.linkedin.com/company/endurance-asia/ https://www.instagram.com/sgfalconsrc/
Alexandra Perel-Winkler is very proud of her MD title, she went to Columbia and worked hard for it, but she still decided to walk away from her prestigious research career to become a soul-centered coach and medicine woman. She's the founder of The Mystic Medicine, where she explores what it looks like to bridge the gap between science and spirit. In this episode, Alexandra shares about her journey from rheumatology fellow to healer, her father's miraculous recovery from pancreatic cancer, and what happened when Andrea experienced a Mystic Medicine ceremony herself just 24 hours before recording this episode.In this episode, we cover:(00:00) Intro(03:15) The childhood yearning to be a healer(05:05) Growing up without language for healing outside of medicine(06:09) A mystical childhood: the stars, the moon, and subtle energies she couldn't explain yet(09:43) Finding Kabbalah(11:31) Why people of deep faith are actually some of her favourite clients to work with(16:33) Nutrition, yoga philosophy, and the microbiome: what she was studying that most MDs weren't(18:04) How her meditation practice and crystal collection both started in New York(22:42) Exploring functional medicine — and why it still wasn't quite it(25:57) Her father's inner knowing, Reiki and visualization(29:38) Why elite athletes use visualization — bridging woo and practical(30:32) Fighting for surgery and her father's unexpectedly strong response to chemo(36:06) What it means to be a "medicine woman" (39:32) The tools Alexandra weaves together(42:05) Andrea's SSRI journey and Alexandra's take(45:24) The real question underneath: do I have the tools now to sit with discomfort?(50:14) What the ceremony actually looked like — and how Alexandra grounds someone before going deep(52:22) Andrea's throat chakra history and the complexity of using her own voice(58:37) "I think I'm tripping out" — the out-of-body moment, and what was actually happening(01:01:43) How vulnerability and voice emerged as the real theme of the ceremony(01:04:39) "We are nature. People don't remember that."(01:09:11) Alexandra's reckoning with entrepreneurship and motherhood(01:11:00) Redefining what success looks likeKEY TAKEAWAYBefore you seek to heal anyone else, you really need to do your own healing first. Whether you're a working mom feeling disconnected from yourself, a high achiever whose body keeps sending signals you keep ignoring, or someone standing at an inflection point wondering who you are without the version of success you've built — the path back isn't through more logic. It's through reconnecting to the essential self you already know is there.About Alexandra Perel-Winkler, MDAlexandra Perel-Winkler is a soul-centered coach and medical doctor who blends science, spirit, and embodiment to help people reconnect with their body, heart, and soul. With 15+ years in Western Medicine and advanced training in Integrative and Functional Medicine, Applied Quantum Biology, neuroplastic coaching, somatic practices, energy work, and intuitive guidance, Alexandra makes the mystical tangible and the abstract approachable. She works with clients in person in Vancouver and virtually through The Mystic Medicine.Connect with Alexandra Perel-Winkler, MDWebsite | https://www.themysticmedicine.com/ Instagram | https://www.instagram.com/themysticmedicine About Andrea Barr, host of All Figured Out:Andrea is a certified career and life coach for parents. Through her coaching, she supports parents in finding better work-life rhythms so they can continue to grow personally and professionally without sacrificing family time.Connect with AndreaWebsite | https://www.andreabarr.com/ Instagram | https://www.instagram.com/allfiguredoutandrea | https://www.instagram.com/allfiguredout.podcast Listen to All Figured Out
In this episode of We Chat Divorce, Karen Chellew and Catherine Shanahan unpack one of the most common—and costly—realities in divorce: financial blind spots within a marriage. Inspired in part by the broader conversation sparked by the popular book Strangers: a Memoir of Marriage , this discussion moves beyond the emotional narrative and into the financial truth many individuals face when divorce becomes real. Because while the emotional impact often gets the attention, it's the lack of financial clarity that can have lasting consequences. Through real client experiences, Karen and Catherine reveal how often individuals enter divorce without a clear understanding of their financial picture. Unknown accounts, overlooked debts, and incomplete visibility aren't signs of irresponsibility—they're the result of financial roles that “worked” until they didn't. The problem is, once divorce begins, you're no longer living within the system—you're being asked to evaluate, explain, and divide it. This episode reinforces a core principle: being financially supported is not the same as being financially informed. Without clarity, decisions are made under pressure, legal costs increase, and long-term outcomes can suffer. That's why My Divorce Solution focuses on financial clarity before legal action—organizing, verifying, and analyzing your full financial picture so you can move forward with confidence, not confusion. About My Divorce Solution We Chat Divorce is produced by My Divorce Solution (MDS) — a financial divorce preparation company dedicated to helping individuals navigate divorce with clarity, confidence, and a strategic financial plan. Founded by Karen Chellew, Legal Liaison, and Catherine Shanahan, Certified Divorce Financial Analyst (CDFA), MDS was created to solve one of the most common and costly mistakes in divorce: entering the legal process without fully understanding your financial picture. Divorce is not just a legal event — it is a financial transition that can shape your long-term security. Through the MDS Divorce Financial Portrait™, clients receive expert financial analysis, organized financial disclosures, and scenario planning to understand how different settlement decisions impact their future. This financial preparation often reduces legal fees, shortens the divorce process, and helps individuals negotiate from a position of knowledge rather than fear.If you are considering divorce or already in the process, you can begin by taking the Free Divorce Financial Assessment to better understand your options. You can also join the MDS Community for expert guidance, educational resources, and live Q&A events designed to help you move from uncertainty to clarity. At My Divorce Solution, the mission is simple: replace fear with knowledge so you can make informed, confident financial decisions during divorce. DisclaimerThe We Chat Divorce podcast (hereinafter referred to as the “WCD”) represents the opinions of Catherine Shanahan, Karen Chellew, and their guests to the show. WCD should not be considered professional or legal advice. The content here is for informational purposes only. Views and opinions expressed on WCD are our own and do not represent that of our places of work.WCD should not be used in any legal capacity whatsoever. Listeners should contact their attorney to obtain advice with respect to any particular legal matter. No listener should act or refrain from acting on the basis of information on WCD without first seeking legal advice from counsel in the relevant jurisdiction. No guarantee is given regarding the accuracy of any statements or opinions made on WCD.Unless specifically stated otherwise, Catherine Shanahan and Karen Chellew do not endorse, approve, recommend, or certify any information, product, process, service, or organization presented or mentioned on WCD, and information from this podcast should not be referenced in any way to imply such approval or endorsement. The third-party materials or content of any third-party site referenced on WCD do not necessarily reflect the opinions, standards or policies of Catherine Shanahan or Karen Chellew.WCD, CATHERINE SHANAHAN, AND KAREN CHELLEW EXPRESSLY DISCLAIM ANY AND ALL LIABILITY OR RESPONSIBILITY FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR OTHER DAMAGES ARISING OUT OF ANY INDIVIDUAL'S USE OF, REFERENCE TO, RELIANCE ON, OR INABILITY TO USE, THIS PODCAST OR THE INFORMATION PRESENTED IN THIS PODCAST. Learn more about your ad choices. Visit megaphone.fm/adchoices
Hot off the presses... it's another freshy fresh from Des and Kara. This was recorded just a few hours after Des ran 2:35 from the main field, and Kara finished commentating the world feed. So... the takes and reactions are as freshy fresh as they can be! You get their thoughts on the races of the day with Korir and Lokedi both defending their titles, and Americans setting all sorts of records on this course. Plus, Des shares the details of her race pacing Ryan after bouncing back from MDS. She was the fastest woman in the main field and second masters on chip time, all with a beer cracked in Newton. Unbelievable running from her and what a day in Boston! Listen in and bask in the after glow with us!
CE PODCAST EST PRÉSENTÉ PAR… MY RAVITO, une nouvelle application mobile qui vous aide à choisir votre nutrition pour les sports d'endurance (plus d'infos ci-dessous)Voici le RÉCAP D+ du 20 avril 2026, le flash info du trail signé Distances+ présenté par Franck Berteau et Chloé Rebaudo.Vous entendrez dans ce podcast :
Send us Fan MailPaper Discussed in this Episode: Advancements in bone marrow biopsy: the role of omics and artificial intelligence in hematologic diagnostics. Maryam Alwahaibi and Nasar Alwahaibi. Front. Med. 2026; 13:1772478.Episode Summary: In this journal club deep dive, we explore a paradigm shift in hematopathology, moving from 19th-century visual assessments to the cutting edge of precision medicine. We examine a 2026 review that unpacks how combining artificial intelligence with multi-omics technologies is transforming the traditional bone marrow biopsy from a static, subjective snapshot into a live, interactive, predictive 3D map. We ask: What happens when deep learning can predict underlying genetic mutations just by analyzing the visual shape and texture of a cell?.In This Episode, We Cover:The Breaking Point of Traditional Diagnostics: Why the 150-year-old gold standard of H&E staining and human visual assessment is hitting a biological and operational wall, plagued by subjectivity, high variability, and observer fatigue.The Multi-Omics Multiverse: Moving beyond standard genomics to unpack the complex biological machinery of the marrow, including:Epigenomics: The biological "switches," like DNA methylation, that control cell fate and can kick off malignant transformation without altering the underlying DNA sequence.Lipidomics: How cellular fats form specialized signaling rafts that actively remodel the marrow's communication network.Microbiomics (The Gut-Marrow Axis): How systemic inflammation driven by gut dysbiosis acts like a massive "traffic jam" that indirectly disrupts local bone marrow homeostasis and blood cell production.AI as the Ultimate Analytical Partner: How artificial intelligence serves as a bridge between physical tissue morphology and high-dimensional molecular data. We discuss AI tools like MarrowQuant for objective cellularity mapping and the Continuous Index of Fibrosis (CIF) that replaces clunky human guesswork with a granular, predictive metric.Predicting Genotype from Phenotype: The revolutionary capability of deep learning models to predict underlying genetic mutations (like TET2 or del 5q MDS) purely from the subvisual, spatial arrangement and shape of cells on a standard slide.Roadblocks and Solutions: Why this technology isn't universally adopted yet. We break down the "black box" problem of AI, the brittleness of algorithms in different clinical settings, and how innovations like Federated Learning and Explainable AI (using heat maps) are overcoming these hurdles.Key Takeaway: The integration of AI and multi-omics is redefining our understanding of bone marrow diseases. By uncovering invisible molecular machinery and objectively translating it through transparent algorithms, we are moving away from subjective human bottlenecks toward a highly personalized, predictive model of hematologic care.Support the showGet the "Digital Pathology 101" FREE E-book and join us!
"Not every patient with myelodysplastic syndrome (MDS) is going to progress and die. Only 10%–20% of them will evolve into acute myeloid leukemia. And not all of them need blood transfusions. Some present with low platelet count. It's not just people who are anemic that have MDS—it's different depending on what type of MDS they have. These are averages. We're giving you statistics based on averages, and you're an individual, so we want to treat you as an individual," ONS member Sara Tinsley-Vance, PhD, APRN, AOCN®, nurse practitioner and quality-of-life researcher at Moffitt Cancer Center in Tampa, FL, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about myelodysplastic syndrome. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by April 17, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Nurses caring for people with myelodysplastic syndrome require knowledge of its pathophysiology, the presenting symptoms, and its diagnosis. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Episode 339: A Lesson on Labs: How to Monitor and Educate Patients With Cancer Episode 302: Patient Navigation Eliminates Disparities in Cancer Care Episode 256: Cancer Symptom Management Basics: Hematologic Complications ONS Voice articles: Manage Cancer-Associated Anemia With Erythropoietin-Stimulating Agents Whole-Genome Sequencing May Guide Treatment Choices for AML and MDS Clinical Journal of Oncology Nursing articles: Deciphering TP53 Mosaic Variants on Germline Biomarker Testing: Implications for Oncology Nurses Myeloid Malignancies: Recognizing the Risk of Germline Predisposition and Supporting Patients and Families Oncology Nursing Forum article: Impact of a Hematologic Malignancy Diagnosis and Treatment on Patients and Their Family Caregivers ONS book: BMTCN™ Certification Review Manual (second edition) ONS Clinical Practice resource: Genomics Taxonomy Genomics and Precision Oncology Learning Library American Cancer Society: Myelodysplastic Syndrome Prognostic Scores Aplastic Anemia and MDS International Foundation Blood Cancer United: MDS Diagnosis HealthTree Foundation Myelodysplastic Syndromes Foundation: What Is MDS? To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "In the bone marrow maturation process, you have a pluripotent stem cell. You have myeloid and lymphoid, and then on the myeloid side, you make your white blood cells, your red blood cells, and your platelets. And during that maturation process, there's this problem that arises. It's called a clonal variation. Or something goes wrong as the cells go through that process year after year. It's called ineffective hematopoiesis. ... That process of becoming mature, functioning cells, arising from that hematopoietic stem cell is broken, and this leads to low blood counts. Usually, it's anemia, so the hemoglobin is low. You can see that the mean corpuscular volume (MCV) is really high, and those are clues that a patient might have MDS—anemia with a high MCV." TS 3:05 "The International Prognostic Scoring System (IPSS) was the first way that we staged MDS into lower-risk and higher-risk disease. Now we have the IPSS-R, which is the revised system. And that was intended to be a way of classifying patients into lower-risk or higher-risk disease, where we talked about the goals being different. And it's really looking at the depth of the cytopenias, so how low are those neutrophils? How low is the hemoglobin and the platelet level? What percentage of blast does the patient have in their bone marrow? [This] gauges whether they have lower-risk or higher-risk disease. And now that we have the Molecular International Prognostic Scoring System (IPSS-M), we also take into account the variants that a patient has and that can really change whether you think they have lower-risk or higher-risk disease." TS 8:46 "During a person's lifetime, if they were a heavy smoker, we always think of lung cancer, but it can actually predispose a person to MDS. If they worked heavily in chemicals. I can remember more than one patient who worked for pesticide companies. Repeated exposure to these things that can affect our blood cells cumulatively, they can make a person more prone to MDS. Also, patients who have family members who have had bone marrow problems." TS 13:39 "The way I explain it to patients who say, 'What does dysplasia mean?' I say, 'Well, if you had a picture of a face. If the cell has too many eyes, or one eye above the other or below the other, or too many ears, or they're just disfigured. They don't look right and they don't mature normally.' And so, the descriptions I frequently see are nuclear budding and micromegakaryocytes. Once you read a lot of the reports, you start to pick out, 'Okay, these are the terms that go along with dysplastic red blood cells or dysplastic megakaryocytes,' which are your precursors to platelets." TS 21:28 "The cytogenetics and the variants—that's a hard concept to explain to patients. And staying current on how we understand the disease and how it evolves. Now we have pre-MDS states called clonal cytopenia of undetermined significance. That was new to me. And then clonal hematopoiesis of indeterminate significance. And some of those clones have other healthcare problems that go along with them." TS 30:52
Voici le 7e épisode de la saison 5 (#87) du talk-show du trail, consacré au 40e Marathon des Sables, une épreuve de 270 km en 6 étapes qui vient de s'achever dans le désert du Sahara, au Maroc.
Host David Johnson interviews Lakshmi Bondu, MDS, MPH, regarding her JMR article What Makes an Experience Positive in a Regulatory Complaint Management Process? A Qualitative Study.
Hosts: Ed Jones (Owner – Nutrition World) & Clint Powell A variety of topics all related to living a healthy life Presented by: Nutrition World www.nutritionw.com Broadcasting from the Nooga Dentistry Studio www.noogadentistry.com Production of: Whitfield Media Group www.vitalhealthradio.com Show Summary & Time Stamps: Title: Saffron as “Nature's SSRI”, GLP-1 Side Effect Mitigation, Holistic Oral Health, & More [0:00:00] – Show Intro [0:01:44] – Ed's Fitness Goal & Using AI Ed's 4:00 a.m. gym routine and training structure. Goal: 14 weeks out from Chattanooga fitness/bodybuilding contest (men's classic over 50/55). Uses AI as a “thinking partner”: Uploads body and meal photos daily. Gets macro/meal feedback and accountability in ~7–8 minutes/day. Reports better progress in 3 weeks with AI than all of last year's prep. [0:05:08] – GLP‑1 / Weight‑Loss Drugs & Protein Strategy Conversation with Be Well Labs about GLP‑1/ozempic‑type drugs: ~1 in 8 people currently on weight‑loss meds; pill form may push toward 1 in 2. Concerns: long‑term side effects, muscle loss, “hijacking” normal physiology. Ed's mitigation tips for those on GLP‑1s: Aim for ~1 g protein per pound of body weight. Most will need two protein shakes/day plus weight training. [0:06:47] – Butyric Acid, Hydrogen Water & Sleep Gains Ed's last 3 weeks: More energy, best sleep/Oura Ring scores he's ever had (scores from ~71 → ~82). Two main changes: Butyric acid (from butter/fiber fermentation): 2 capsules in the morning. Supports gut lining, may have GLP‑1‑like effects. Hydrogen water: Uses a hydrogen bottle and tablets; must drink quickly after dissolving. Hypothesis: combination is improving gut health, inflammation, and overall well‑being. [0:10:18] – Dollar General “Stranded” Series New mini‑series concept: “What would Ed Jones do if stranded in a rural town and only had Dollar General for meals?” Finds ~12 foods (out of ~2000) he'd eat regularly. Message: even in limited environments (Dollar General, fast food), you can still find better choices. Content to appear on Instagram, Facebook, (possibly YouTube). [0:15:58] – Tallow, French Fries & Processed Carbs Rib & Loin (local BBQ restaurant) reportedly using beef tallow. Ed on fats: Prefers tallow (stable saturated fat) over seed/vegetable oils. Critiques decades of low‑fat dogma and resulting high‑carb intake and heart disease. Notes potato farmers discarding crops: Impact of GLP‑1 drugs on restaurant demand. Growing awareness of harm from processed carbs. Hydrogen‑rich “healing” waters story (German mine, Mexico, Japan) → dissolved molecular hydrogen theme. [0:22:17] – Oral Health, Tooth Powder & Mouth Microbiome Ed's dental routine: cleanings every 3 months. References his oral health e‑book (searchable via NutritionW.com). Product mention: Echo Dent Daily Care Tooth Powder: Chosen because it does not annihilate mouth bacteria. Key idea: chronic use of strong mouthwashes (even “natural” ones) may: Damage oral microbiome. Be linked to higher Alzheimer's risk via “bad” oral bacteria. Occasional disinfecting is fine (e.g., sore throat), but avoid twice‑daily “scorched earth” approach. [0:26:33] – Niacinamide, Glioblastoma & High Iron Study highlight: High‑dose niacin/niacinamide (B3) may support immune activity and short‑term outcomes in glioblastoma. Niacinamide boosts NAD (cellular energy/anti‑aging cofactor). Already used by dermatologists to help lower skin‑cancer risk. High iron / ferritin: Ferritin >100: likely inflammation or iron overload. Ferritin >200: pathological; associated with shorter lifespan. Action step: Test iron/ferritin (e.g., at Be Well Labs / beginwithlabs.com). If high, consider regular blood donation to lower iron. [0:34:42] – SSRIs & Antidepressants with Dr. Kurt Deering Guest: Dr. Curt Dearing, clinical pharmacist (30+ years). SSRIs discussed: Prozac, Celexa, Lexapro, Paxil, Zoloft. Effectiveness vs placebo: Placebo response in depression is high (~40%+). SSRIs only modestly better than placebo in many trials. Typical course: Weeks 1–2: patients often feel worse. Weeks 3–4: back to baseline. Weeks 4–6: if helpful, benefits show here. [0:40:44] – SSRI Side Effects, Withdrawal & Risks Common side effects: Nausea, vomiting, diarrhea, sweating, headaches. Sleep disturbance (insomnia or excessive sleepiness). Anxiety, jitteriness, tremors, dry mouth. Long‑term issues: Sexual dysfunction (very common). Weight changes (often weight gain). Withdrawal (if stopped abruptly): Anxiety, dizziness, flu‑like symptoms, insomnia. “Brain zaps” – electric‑shock sensations that strongly discourage abrupt stopping. Boxed warning: Increased suicidal thoughts/behaviors, especially 18–24‑year‑olds. [0:48:03] – Natural & Lifestyle Alternatives (Green Pharmacy) Strong caveat: never stop/taper SSRIs without coordinating with the prescribing clinician. Nutrient foundations: Vitamin D adequacy for mood and depression. Low‑dose lithium (as a micronutrient, e.g., lithium orotate): Supports brain health, reduces inflammation, may aid depression/anxiety/cognitive health. Omega‑3s, especially EPA, for mood support. Herbs & natural options: St. John's Wort, ashwagandha, saffron. Lifestyle interventions: Exercise (research shows it can match or beat standard depression care). Sunlight, sleep quality, mindfulness/prayer, overall holistic changes. Team approach: Add trainers, nutritionists, holistic practitioners alongside psychiatrists/MDs. [0:50:52] – Saffron as “Nature's SSRI” Clinical evidence: Meta‑analyses: saffron ≈ SSRIs in effect for mild–moderate depression. Faster onset (often 1–2 weeks). Side‑benefits: Heart health, anti‑inflammatory, lipid‑lowering. Cognitive support (including in Alzheimer's studies). PMS symptom relief. Eye health (age‑related macular degeneration support, intraocular pressure). Better sleep (duration and quality). Weight management (reduced appetite, body weight, waist circumference). Improved libido and sexual satisfaction (opposite of many SSRIs). [0:56:44] – Offers, Products & Closing WishGarden immune products: Immune boost for pregnancy. Kids' immune support formula (often mixed with honey for taste). Free bottle for the first 10 in‑store visitors mentioning the show (time‑limited). NoogaPodcasts.com: Clint promotes his local podcast network (crime, politics, adventure, health, faith, veterans, etc.). Fireside Herbicide: Plant‑desiccating herbicide that dehydrates weeds instead of poisoning soil. Less harmful to earthworms and soil life vs glyphosate products. Sign‑off: Radio airing on Sundays, podcast version (“Vital Health Radio”) drops Tuesdays. Thanks to listeners and mention of Nutrition World as primary sponsor. The post Radio Show / Podcast – April 5, 2026 first appeared on Vital Health Radio.
Ce podcast est présenté par BeTrail.Voici le RÉCAP D+ du 6 avril 2026, le flash info du trail signé Distances+ présenté par Franck Berteau et Chloé Rebaudo.Vous entendrez dans ce podcast :
In this episode of The Better Life, Dr. Pinkston welcomes Dr. Sherry McAllister, President of the Foundation for Chiropractic Progress and author of Adjusted Reality. Together, they dive deep into the often-misunderstood world of chiropractic care, stripping away decades of stigma to reveal a health model centered on the body’s natural ability to heal, adapt, and perform. Dr. McAllister shares her personal journey from a life-altering accident to becoming a leading advocate for "whole-being care." The conversation explores the Caregiver Paradox—why women often suppress trauma and stress to care for others, leading to chronic pain and autoimmune issues—and how restoring alignment can flip the switch from surviving to thriving. Key Topics Covered: Debunking Chiropractic Myths: The history of the "contain and eliminate" era and why modern collaboration between MDs and Chiropractors is the future of medicine. The Vagus Nerve: Understanding your body's "reset button" and how it governs rest, repair, and immune function. The Second Brain: How gut health influences mental clarity and physical well-being. Lifestyle Alignment: Six simple, actionable steps to start your health investment today, from Box Breathing to Cold Exposure. The Power of Posture: Why "Tech Neck" is more than just an ache—it’s a disruption of your nervous system’s communication highway. See omnystudio.com/listener for privacy information.
We missed you last week as Kara was on vacation, and the internets weren't cooperating for a recording session. So... we are back this week with a longer episode to catch up on all the latest in life and running news. Grab your favorite cocktail or mocktail and get cozy! We start with extended life updates. Kara breaks down Colt's amazing race at New Balance Indoor Nationals in Boston, where he won his heat in the mile. You get all of the proud-parent moments from Kara and some great perspective on supporting your kids in their dreams. She then shares about her amazing spring-break vacation to St. Maarten with friends, where beach time was what the doctor ordered. Cosmos were served nightly as Kara channeled her inner Carrie Bradshaw. Who knew she was a Sex and the City fan?! Des talks about her weekend in Oakland where she used a half marathon as a training race and did some final testing with GU Energy to dial-in nutrition and hydration for MDS. She also discusses the result from her VO2Max test there, where nerves and her heart rate went to the max. Shout-out to GU for their extra support of Des for her race! Then, they turn to a long list of running news with some controversial topics, including: Jane Hendengren indoor NCAA titles DQ in the men's 3K at NCAAs D3 podium controversy involving Seth Clevenger 2:10 marathon debut for Fotyen Tesfay (and the associated chatter) Grant Fisher's half debut in NYC All of the action from World Indoors, including so many medals for Team USA, and another amazing battle between Hocker, Kerr, and Nuguse As always, they finish with a Top 5 to round out the episode including a warm welcome to team Brooks for Clayton Young! Thank you to Brooks Running and ButcherBox for sponsoring this one. As an exclusive offer from ButcherBox, our listeners get their choice of organic ground beef, chicken breast OR steaks added to every box for a year, PLUS $20 off on your first box when you go to ButcherBox.com/nobody. That's right - your choice of organic ground beef, chicken breast or steak in EVERY box for an entire year, PLUS $20 off your first box, and free shipping always! Check it out at the link above.
This week on the Missouri Woods & Water Podcast we get the pleasure to sit down with Brandon, Jesse, Tom, and Jake about the Missouri Disabled Sportsmen's Annual Coyote Hunt. First, we talk about MDS in general and some of the awesome things they do to get youth and mobility impaired folks outdoors. Next, we get into this year's coyote hunt and all the fun stories that came from it. Make sure you check out MDS and all they have to offer at our link below and consider helping them out! Missouri Disabled Sportsmen Website Check out the MWW Website for shows, partner discounts, and more!!! Subscribe To Our YouTube Channel!!! Jason Patterson Land Team - Whitetail Properties Grundy County, MO Elite Hunting & Income Producing Farm with 2 Homes & Outbuildings Platte County, MO 225.47 Acre Hunting Farm & Lodge with Waterfowl, Quail, Woodcock, Turkeys & Deer HUXWRX Athlon Optics Midwest Gun Works Lucky Buck OnX Use code MWW20 for 20% off
Episode Overview: In this practical episode of the Long Term Care RD podcast, Michelle breaks down a real-world sample nutrition care plan for a resident with a stage 3 pressure injury. Drawing from over a decade in SNFs, we cover the Nutrition Care Process step-by-step, MDS requirements, and tips to make your documentation survey-ready while supporting better healing for your older adults. Whether you're juggling MDS deadlines or looking for quick interventions to boost protein intake, this episode is designed to save you time and build your confidence in geriatric wound care.Key Takeaways:How to craft a specific Nutrition Diagnosis (PES statement) for increased protein/energy needs tied to wounds.Setting measurable goals for healing, weight maintenance, and intake — with geriatric nuances like potential weight gain.Multi-layered interventions: From fortified foods and ONS to interdisciplinary referrals (e.g., OT for positioning).Monitoring strategies to stay proactive on quality measures and prevent burnout.A ready-to-adapt sample chart note in SOAP format for your own residents.Resources Mentioned:Downloadable Your FREE RD Starter Kit!: Grab the full example we discussed, including the resident briefing, NCP details, MDS section, and chart note. Available as a free teaser on https://fantastic-frost-95925.myflodesk.com/ggnskwevs8 — perfect for quick reference in your facility.Full Wound Healing Toolkit in Clinical Nutrition Central: For even more depth, join the membership to access downloadable templates for all wound stages, PES statement guides, charting libraries, monthly updates on CMS regs/PDPM, and a community forum for LTC RDs. Designed by someone who's been in your shoes, for RDs working with older adults. Check it out at https://clinicalnutritioncentral.comRelated Blog Post: "Wound Care Dietitian - Step by Step Practical Advice" — Read it free at https://longtermcarerd.com/wound-care-the-dietitians-role2/.Thanks for Listening! If this episode helped you feel a bit more equipped for those wound care challenges, share it with a fellow RD and subscribe for more practical geriatric nutrition tips. Got questions or episode ideas? Drop a comment on the blog or join us in Clinical Nutrition Central. You've got this — let's keep supporting our seniors together.Hosted by Michelle Saari, MS, RD LongTermCareRD.com | ClinicalNutritionCentral.com
Dr. Eduardo de Pablo-Fernández is joined by Dr. Susan Fox and Dr. Claudia Trenkwalder to discuss how to improve the current MDS clinical diagnostic criteria for Parkinson's disease. Read the article.
In this episode, we dive deep into ASH 2025 updates on myeloid malignancies with Dr. Curtis Lachowiez. From the plenary halls of ASH 2025 to long-term follow-up of Aza/Ven/Gilteritinib, we unpack what the latest evidence means for the future of AML management.1. PARADIGM Trial (Plenary Session, Abstract 6)Fathi A, Perl A, Fell G, et al. Results from PARADIGM – a phase 2 randomized multi-center study comparing azacitidine and venetoclax to conventional induction chemotherapy for newly diagnosed fit adults with acute myeloid leukemia. Blood 2025;146(Suppl 1):6.https://doi.org/10.1182/blood-2025-6ClinicalTrials.gov: NCT048017972. VICEROY Study – Aza/Ven/Gilteritinib Triplet (Abstract 654)Venetoclax (VEN) and azacitidine (AZA) with gilteritinib (GILT) in patients with newly diagnosed FLT3mut+ AML ineligible for intensive induction chemotherapy: Interim results from the phase 1/2 VICEROY study. Blood 2025;146(Suppl 1):654.ClinicalTrials.gov: NCT055205673. Long-Term Follow-Up of Aza/Ven/Gilteritinib in FLT3-Mutated AML (Abstract 45)Azevedo RS, et al. Long-term follow-up of azacitidine, venetoclax, and gilteritinib in patients with newly diagnosed FLT3-mutated acute myeloid leukemia. Blood 2025;146(Suppl 1):45.Original publication: Short NJ, Daver N, DiNardo CD, et al. J Clin Oncol 2024;42:1499–1508. https://doi.org/10.1200/JCO.23.01911ClinicalTrials.gov: NCT041404874. PRISM-AML Score (Abstract 453)Lachowiez CA, et al. Prognostic risk integration for survival modeling (PRISM) in newly diagnosed acute myeloid leukemia treated with venetoclax: A multinational retrospective cohort study. Blood 2025;146(Suppl 1):453.Interactive Calculator: https://prism-aml.com5. Additional Studies Referenced in Discussion• VIALE-A Trial: DiNardo CD, et al. Azacitidine and venetoclax in previously untreated acute myeloid leukemia. N Engl J Med 2020;383:617–629. (NCT02993523)• VERONA Trial: Randomized study of Aza-Ven vs. Aza vs. placebo in MDS (discussed as a negative study)• 4-Gene Classifier (mPRS): Bataller A, et al. Prognostic risk signature in patients with AML treated with HMA and venetoclax. Blood Adv 2024;8(4):927–935. https://doi.org/10.1182/bloodadvances.2023011757• LACEWING Trial: Azacitidine plus gilteritinib vs. azacitidine plus placebo in FLT3-mutated AML (discussed as a negative study)
This is the first episode in a three-part series I'm calling Dr. Ospina Explains. In this series, we'll dive into topics many of you have been asking about recently. One of my favorite Movement Disorder Specialists, Dr. Ospina, has a wonderful way of explaining all things Parkinson's in terms that are easy for the rest of us to understand. I hope you'll tune in to all three parts as they're released — I truly believe you'll learn a lot. We're starting with Botox. Like many people, I used to think Botox had only one purpose — cosmetic. But after speaking with Movement Disorder Specialist Dr. Marie Ospina, I learned that Botox can actually help treat several symptoms that occur in people living with Parkinson's. You'll discover exactly what those symptoms are when you listen to my conversation with Dr. Ospina. I think you may be surprised — and you might even find yourself asking your MDS or neurologist whether Botox could help relieve some of your pain or muscle tightness. Stay tuned! Thank you to our sponsor – Boston Scientific, the maker of Vercise Genus, a Deep Brain Stimulation or DBS system. To learn more about the latest treatment options for Parkinson's disease at https://DBSandMe.com/17branches
Proactive Care Is a Pathway — Not a SloganPT is built for prevention.But most of healthcare still waits until pain shows up.In this episode recorded live at CSM in Anaheim, Dr. Tatiana Olevsky discusses:Why patients still go to MDs first for MSK painThe public awareness gap around direct accessHow PTs can shift from reactive rehab to proactive performanceWhy outcomes — not visit counts — should define our valueLessons from Pilates and community-buildingMovement analysis as a preventative toolWhy PT is at an inflection pointKey TakeawaysPrioritize quality over quantityScreen upstream before pain becomes diagnosisBuild rapport before educationShow patients the future, don't just prescribe sets and repsIf PT wants to be first-line, we must earn itGuest InfoDr. Tatiana Olevsky Spine PT Fellow | Private Practice Owner | Educator
Guest: Dr. Rachel Zoffness – Pain Psychologist | UCSF + Stanford Faculty | Author of Tell Me Where It HurtsTopic: Revolutionizing Pain Education and TreatmentWhat You'll Learn in This Episode:Why the brain—not the body—is the control center for painHow chronic pain can be managed and treated (not just medicated)Real case study: “Sam” and the power of biopsychosocial careWhy PTs, MDs, and psychologists must collaborateWhy medical education fails to teach modern pain scienceHow you can create your own “pain recipe” for better outcomesBehind the scenes of Rachel's new book, publishing journey & outreachLinks + Resources???? Website: zoffness.com???? Book: Tell Me Where It Hurts — Order Now???? Follow: @TheRealDocZoff, @drzoffness???? Want Rachel to record your voicemail? Preorder and submit at zoffness.com
A $400 million exit and a reputational reckoning in wellness put this episode of Taste Radio on edge, as the team dissects Bachan's blockbuster acquisition and the fallout facing brands tied to wellness guru Peter Attia. The conversation also spotlights Solely's growth strategy in an interview with Manish Amin, VP of marketing for the fast-growing organic fruit snack brand. Show notes: 0:23: Many Meetups. Marzetti's Move. Attia Outta Here. Will Shat? DKB, MDS, MHH. – The hosts preview Taste Radio's packed year of networking events and live podcast meetups, kicking off in Miami. The hosts turn their attention to Marzetti's $400 million acquisition of Bachan's, examining how the Japanese barbecue sauce brand emerged as a standout CPG success story. They also dive into tougher conversations around reputational risk following recent revelations involving wellness influencer Peter Attia. Ray teases a surprising celebrity partnership between William Shatner and Raisin Bran, before the hosts spotlight new products from Dave's Killer Bread, Mid-Day Squares, Tama Tea, Tart Beverages, and Mike's Hot Honey Syrup. 28:16: Interview: Manish Amin, VP of Marketing, Solely – Ray sits down with Manish at the recent Naturally San Diego event to discuss Solely's mission and product lineup. Manish shares the brand's focus and positioning, emphasizing a commitment to genuinely good-for-you, great-tasting products. He also highlights Solely's role in pushing the broader snack industry toward cleaner labels and better ingredients. Brands in this episode: Solely, Bachan's, Marzetti, Olive Garden, Chick-fil-A, Buffalo Wild Wings, Arby's, Subway, Texas Roadhouse, New York Bakery, Sister Schubert's, AG1, Magic Spoon, LMNT, David Protein, Kellogg's Raisin Bran, Smart Bran, Dave's Killer Bread, Mid-Day Squares, Tama Tea, Tart, Mike's Hot Honey, Jolly Rancher, Red Hots, Absolut Vodka, Tabasco
We are joined by Crystal Clark, who has completed the MDS, a 250km stage race, self supported and various other ultras! She is now coaching and shares her adventures and outlook on running. Schuyler Hall fills in for Brother Bill, who is under the weather..
The buzz is real when it comes to Des's trail plans for this year. She just announced her first trail race of the season - the Black Canyon 50K - on February 15th in prep for the epic stage race Marathon des Sables (MDS) in April. MDS is a self-supported, multi-stage ultramarathon, primarily held in the Moroccan Sahara, where runners cover ~250 km (155 miles) in six days, carrying all their own food and gear while facing desert conditions, and sleeping in communal tents with other participants. We know Des likes a sufferfest, so it shouldn't be surprising that this race has captured her attention. She gives a little preview of her prep and opens the floor for some help for her team name. Drop your ideas in the YouTube or Spotify comments! Then, Des and Kara talk about the impending choice for the host city of the 2028 Olympic Marathon Trials. Phoenix and St. Louis go head-to-head for the opportunity to choose our Olympic marathoners for LA. What factors should be considered and which city might have the edge? Finally (before a Top 5), they preview the indoor track action coming up at the NB Indoor Games and at Millrose. There are some fun and exciting races to watch in the coming weekends, and they give you some tips on what and who to watch! Track is back! Thank you to Lagoon Sleep for sponsoring this podcast. Take the quiz to find your ideal pillow and use code NOBODYASKEDUS for 15% off at LagoonSleep.com/NOBODYASKEDUS.
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