Podcasts about Membrane

ReferencesGuerra, DJ. 2025. Membrane lipids lectures.Langmuir 2019 35.30 9944-53Jones, S. 1948. "Ghost Riders in the Sky" Johnny Cashhttps://music.youtube.com/watch?v=3LtmZM0OWO8&si=iayTIDz_eqmYo9naHunter, R.1978. "Rose of Sharon."https://youtu.be/-4PAVeswqME?si=dyz3dOFh-X-dTQT2&t=1Gibson, D. 1957. "Oh, Lonesome Me".https://music.youtube.com/watch?v=dzYe6O5IJWs&si=eUItyJN9JoHtxIWnVan Zandt and Collins. 1978. "Tuesday's Gone Lynyrd Skynyrdhttps://music.youtube.com/watch?v=LJrFxnvcWhc&si=VDOw8DM4zbrSuyJj

we talk with Ram Long in a 4 hour 2 part session .. we had a great time and really let loose so enjoy ...PART 2 WILL BE RELEASED NEXT WEEK ..

A new efficient way to isolate rare earths was discovered at UT. A very necessary move foward in light of our recent clash with China.  https://www.msn.com/en-us/news/technology/rare-earth-element-extraction-breakthrough-could-boost-us-position-in-critical-tech/ar-AA1E3KVU?ocid=socialshare&cvid=e78be75f2c5546729895e12909c86ca3&ei=22

Saviez-vous que le choix entre un détendeur de plongée à piston ou à membrane peut tout changer selon le type d'eau dans lequel vous plongez ? Ou qu'un détendeur surcompensé vous permet de respirer plus facilement dès les premiers mètres de descente ?Dans cet épisode, Lucie et Manuel Cabrère (Aqualung) vous plongent au cœur de la mécanique interne des détendeurs de plongée, avec un focus sur les subtilités qui font toute la différence en termes de confort respiratoire.A travers un échange limpide et pédagogique, vous découvrirez :la différence entre les détendeurs à piston et à membrane, et pourquoi la membrane est à privilégier en milieu chargé ou pollué ;le rôle crucial de la compensation, qui permet de maintenir une respiration fluide quel que soit le niveau d'air restant dans la bouteille ;la mécanique de la surcompensation, une technologie qui améliore encore le confort respiratoire en profondeur, même dès 25 mètres.A travers des analogies simples — comme celle du bouchon de baignoire — Manuel rend accessibles des concepts techniques fondamentaux pour bien choisir et bien comprendre son matériel. Vous apprendrez également pourquoi certains détendeurs disponibles à la location dans la plupart des clubs de plongée peuvent montrer leurs limites, et comment un bon choix de détendeur peut transformer votre expérience sous l'eau.Ce deuxième épisode technique poursuit notre série sur les détendeurs de plongée avec clarté et précision. Un must pour les plongeurs qui veulent comprendre, sans se noyer dans le jargon !

One of the reasons why working in water is fun is the people who work in it - dedicated, driven, modest, self-effacing, hard working, but with a lightness that comes from doing something that really matters. Craig Beckman personifies these qualities and then some, and he also happens to be working on a generational - and I really do mean that it's once in a generation if the past is anything to go by - generational shift in the design of the spiral wound membrane module. Well, we'll go into it in the episode, but think of it as the basic building block, the workhorse of water treatment, a $4.6 billion a year market growing at 11%. Craig and his team have the opportunity to make something we all rely on, whether we know it or not, fundamentally better. It's such an exciting story from inception to development to their enormous production space they just moved into. But more than anything, Craig is a wonderful person to spend time with. Please enjoy my conversation with Craig Beckman. Subscribe to The Fundamental Molecule here: https://www.burntislandventures.com/the-fundamental-molecule For the full show notes, transcript, and links to mentioned content, check out the episode page here: https://podcasts.apple.com/us/podcast/the-fundamental-molecule/id1714287205 ----------- Craig Beckman shares lessons learned from GE Water and MIOX on customer needs and small company agility here today. He describes how his current venture, Aqua Membranes, revolutionizes membrane elements by replacing inefficient mesh spacers with optimized, 3D-printed structures - an innovation that targets reduced fouling and energy use, especially in industrial reuse. Discussing focused go-to-market strategies, overcoming technical challenges, and scaling production to build confidence, Craig emphasizes membrane technology's crucial role in future water security and advises persistence for water entrepreneurs. 00:00 - Building the Future of Water Through Innovation 01:59 - Lessons from Big Company Sales and GE Water Rollups 05:10 - Why Big Companies Miss Mid-Market Water Opportunities 09:18 - Balancing Recurring Revenue with Customer Needs 13:31 - Why Traditional Membrane Spacers Fail in Water Treatment 17:24 - Redesigning Membranes for High-Reuse Industrial Wastewater 21:54 - Solving Customer Pain with Elegant Membrane Engineering 27:44 - Overcoming Doubt and Manufacturing Complexity in Water Tech 31:05 - Go-to-Market Strategy for Industrial Water Startups 35:10 - Building Case Studies to Accelerate Market Adoption 39:04 - Scaling Manufacturing to Gain Customer Trust 42:19 - The Future of Membranes in Global Water Scarcity Solutions 45:04 - The #1 Advice for Water Entrepreneurs Links: Burnt Island Ventures: https://www.burntislandventures.com/ Craig Beckman: https://www.linkedin.com/in/craig-beckman-ceo/ Aqua Membranes: https://aquamembranes.com/ SM Material Key Takeaways: "Just because everyone has wastewater doesn't mean it's a good commercial opportunity." "The membrane market is poised for growth. It's a critical need for food and water security." "Persistence is key in water entrepreneurship. Be patient. Water's impact grows over time." "In water treatment, solving problems for customers is about aligning with their needs, not just trends." "Cash flow is crucial in startups. It's a lesson learned from experience." "The speed at which opportunities are pursued is crucial. Big companies often can't get out of their own way."

Join host Dr. Joe Patterson as he chats with Dr. Geoffrey Marecek about the debate in bone grafting compared to bone transport for the treatment of bone defects. For additional educational resources visit OTA.org

In this episode, Dr. Sterling discusses cervical exams during pregnancy and labor, emphasizing patient consent and comfort. Learn about why these exams are performed, how to make them more comfortable, and get a brief introduction to membrane sweeping as a potential labor-inducing procedure.Key MomentsYour Right to ConsentPurpose of Cervical ExamsBishop Score ExplainedMaking Exams More ComfortableIntroduction to Membrane SweepingConnect With Us: Join the Sterling Parents community at sterlingparents.com Follow us on Instagram @askdrsterlingpodcast Email your questions to podcast@sterlingparents.com

The Industrial Water Solutions Conference in June is co-hosted by WateReuse and WEF. Anthony Zamora, Principal Environmental Engineer at CDM … More

Send us your feedbackWhat is epiretinal membrane? In this episode of the My Macular and Me podcast, we are joined by Dr. Teresa Sandinha, consultant ophthalmologist at the Royal Liverpool University Hospital and Geraldine Hoad, our head of research grants at the Macular Society, to explore this topic. If you've been diagnosed with an epiretinal membrane or you are curious of how it affects vision, this episode will provide clarity of what it is, why it develops, and what treatment options are available. The Macular Society has been supporting people with macular conditions for over 30 years. The right information and support can help people overcome their worries and retain their independence. We provide free information and support to those with macular disease, along with their family and friends. If you or a family member need advice or support, please make sure to reach out. No one has to face macular disease alone. Please call us on 0300 3030 111.

  Are you ready to discover the unexpected key to prospecting success that even the most seasoned sales professionals may have overlooked? Brace yourself for a surprising revelation that will transform the way you approach sales engagements. Get ready to uncover the game-changing solution that's been right under your nose this whole time. Stay tuned for the jaw-dropping insight that will revolutionize your prospecting efforts and take your sales game to the next level. Achieve Better Prospecting Engagement If you're feeling overwhelmed by the prospecting challenges and struggling to engage potential clients, then you are not alone! The traditional sales methods just don't seem to be cutting it and it's time to shake things up. Let's explore how to achieve greater prospect engagement and success through personalized, empathetic selling. It's time to transform your sales game and make prospecting a breeze! In this episode of The Modern Selling Podcast, Mario Martinez Jr. recounts his unorthodox entry into the sales world, transitioning from a photo finisher to a highly successful salesperson. He underscores the importance of trust-building and genuine assistance in sales, rather than aggressive tactics. Throughout the conversation, key themes such as the challenges of modern prospecting, the integration of human intelligence with AI, and the impact of personalized communication on sales strategies emerge. Mario's personal journey serves as a testament to the resilience and dedication required in the sales profession, offering valuable insights for aspiring sales professionals. His practical advice and emphasis on adapting to the evolving sales landscape make this episode essential for those seeking to enhance their sales efforts. The hardest part about selling is not anything but prospecting. - Mario Martinez Jr. In this episode, you will be able to: Overcome Sales Prospecting Challenges: Learn effective strategies to conquer common obstacles and boost your prospecting success. Harness the Power of Human Assisted AI in Sales: Discover how the fusion of human touch and AI technology can supercharge your sales efforts. Elevate Your Sales Cadences with Referrals: Uncover the pivotal role referrals play in enhancing your sales process and driving better results. Master Personalization Strategies for Sales Success: Unleash the potential of personalized selling to forge stronger connections and win more deals. Leverage LinkedIn for Modern Sales Strategies: Explore the impactful role of LinkedIn in shaping contemporary sales approaches and expanding your reach. The key moments in this episode are: 00:00:00 - The Power of Sales Coaches and Managers 00:00:30 - Leveraging AI in Sales 00:00:43 - Mario's Journey into Sales 00:03:39 - Overcoming Financial Challenges 00:10:40 - Hunter's Revelation 00:11:16 - Hunter Anderson's Advice 00:14:21 - Diverse Sales Experience 00:18:12 - Modern Buyer Challenges 00:20:48 - Engaging Modern Buyers 00:25:54 - The Importance of Personalization in Sales Prospecting 00:26:34 - The Limitations of AI in Sales 00:27:58 - The Role of Personal Investment in Sales 00:29:39 - Leveraging Human-Assisted AI in Sales 00:30:16 - The Power of Referral in Sales Cadences 00:39:58 - The Art of Helping in Sales 00:40:13 - Spreading Wisdom and Knowledge 00:40:30 - Elevating Each Other 00:40:47 - Podcast Rating and Productivity Tip Timestamped summary of this episode: 00:00:00 - The Power of Sales Coaches and Managers Mario discusses the importance of sales coaches and managers who can share success stories and help their team overcome the challenges of prospecting. 00:00:30 - Leveraging AI in Sales Mario emphasizes the need to combine human intelligence with AI tools to achieve real results in sales. 00:00:43 - Mario's Journey into Sales Mario shares his inspiring journey into sales, starting from his time as a photo finisher and how he transitioned into B2B software sales. 00:03:39 - Overcoming Financial Challenges Mario recounts how he applied for numerous scholarships and worked part-time to pay for his education at UC Berkeley, showcasing his resilience and determination in the face of financial obstacles. 00:10:40 - Hunter's Revelation Mario recounts the pivotal moment when his district manager, Hunter, recognized his sales skills while working as a photo finisher, leading to a significant turning point in his career. 00:11:16 - Hunter Anderson's Advice Hunter Anderson recognized Mario Martinez Jr.'s sales potential and advised him to pursue a sales role, leading to a successful career in sales. 00:14:21 - Diverse Sales Experience Mario Martinez Jr. discusses his diverse sales experience, serving various industries and segments, managing large teams, and his journey from a sales intern to a successful sales professional. 00:18:12 - Modern Buyer Challenges Martinez highlights the challenges faced by salespeople in engaging with modern digital buyers, emphasizing the importance of omni-channel approaches and hyper-personalization in sales prospecting. 00:20:48 - Engaging Modern Buyers Martinez shares insights on the need for hyper-personalization and value-driven messaging in engaging modern buyers, emphasizing the importance of PVC sales methodology and the limitations of traditional prospecting methods. 00:25:54 - The Importance of Personalization in Sales Prospecting Mario emphasizes the importance of personalization in sales prospecting. He discusses the significance of getting a prospect to say yes and the need for human-assisted AI in the sales process. 00:26:34 - The Limitations of AI in Sales Mario talks about the limitations of AI, highlighting that AI can be two-dimensional and may not fully grasp contextual relevance. He stresses the necessity of human intelligence in sales to complement AI. 00:27:58 - The Role of Personal Investment in Sales Mario discusses the need for sales reps to invest in their own tools and technologies to enhance their effectiveness, rather than solely relying on the organization. He highlights the importance of personal initiative in sales success. 00:29:39 - Leveraging Human-Assisted AI in Sales Mario emphasizes the significance of aligning human intelligence with AI in sales. He stresses the need for real intelligence in using AI effectively to connect person-to-person, rather than solely relying on AI capabilities. 00:30:16 - The Power of Referral in Sales Cadences Mario emphasizes the importance of starting sales cadences with referrals, highlighting that 84% of buyers start their buying process with a referral. He emphasizes the need to transform LinkedIn profiles to engage buyers effectively. 00:39:58 - The Art of Helping in Sales Myra emphasizes the importance of prospecting and invites the audience to learn more. Mike emphasizes that sales is the art of helping, highlighting the need for collaboration and support in the sales world. 00:40:13 - Spreading Wisdom and Knowledge Mike encourages the audience to like, subscribe, and share the podcast to spread wisdom and knowledge in the sales world. He emphasizes the critical nature of understanding and helping each other in the industry. 00:40:30 - Elevating Each Other Mike encourages the audience to keep shining bright and have an amazing day, emphasizing the importance of lifting each other up. He highlights the need for mutual support and collaboration in the sales industry. 00:40:47 - Podcast Rating and Productivity Tip Mike asks for a 5-star rating and review for the podcast on iTunes. He also recommends downloading FlyMSG to save time and increase productivity in writing.   The resources mentioned in this episode are: Visit FlyMSG.ai to try the AI-powered sales prospecting tool for free. No credit card required. Check out Vengreso, Inc. at vengreso.com to learn more about their sales training and prospecting solutions. Connect with Mario Martinez Jr. on LinkedIn and mention that you heard him on the Membrane podcast to engage with him directly. Watch Vengreso, Inc.'s referral training video on YouTube for a comprehensive guide on how to ask for referrals in your sales process. Download FlyMSG at flymsg.io to save 20 hours or more in a month and increase your productivity with a free text expander and personal writing assistant.

This week The President of The United States of America and Tech Stuff Guy discuss Sleepy Joe Pardons, Iran, Stockmarket, St. Patricks Day, NCAA Tournament, and more. We are also joined by Don Jr for a short recap of what is going on in his life. If you enjoy the show leave a rating and review on spotify or iTunes. Join the Patreon for hours of bonus content www.Patreon.com/MPGA Learn more about your ad choices. Visit megaphone.fm/adchoices

Gm! This week we're joined by Carson Cook & James Roth from Membrane Labs to discuss the current state of crypto lending. We deep dive into the differences between crypto's 2021 cycle & today, the Terra/Luna fallout, institutional appetite for lending in crypto & much more. Enjoy! -- Follow James: https://x.com/juniorroth22 Follow Carson: https://x.com/LiquidityWizard Follow Jason: https://twitter.com/JasonYanowitz Follow Empire: https://twitter.com/theempirepod Join the Empire Telegram: https://t.me/+CaCYvTOB4Eg1OWJh Start your day with crypto news, analysis and data from Katherine Ross. Subscribe to the Empire newsletter: https://blockworks.co/newsletter/empire?utm_source=podcasts -- Use Code EMPIRE10 for 10% off tickets to Digital Asset Summit 2025: https://blockworks.co/event/digital-asset-summit-2025-new-york -- ZKsync is the pioneering zero-knowledge technology powering the next generation of builders with limitless scale. Secured by math and designed for native interoperability, ZKsync enables an elastic, ever-expanding network of customizable chains. Deeply rooted in its mission to advance personal freedom for all, the ZKsync technology makes digital self-ownership universally available. To learn more about ZKsync, visit http://www.zksync.io -- Token.com is a social-first crypto platform transforming how people discover and trade through crypto content. The revolutionary in-feed trading turns complex crypto into intuitive investments, while content creators earn from every trade and projects amplify their stories through native tokens - creating a new era of social media-powered crypto discovery. Just scroll to watch and tap to invest. Download the app! -- Get up to speed on the biggest stories in crypto each week. In five minutes. Get the Bitwise Weekly CIO Memo delivered directly to your inbox at bitwiseinvestments.com/ciomemo/empire -- WalletConnect is the onchain connectivity network . If you've connected to a Web3 app, you've seen WalletConnect. It's everywhere—an icon of trust in crypto, as recognizable as Visa at checkout. The numbers speak for themselves: Over 220 million connections and 35 million users worldwide use WalletConnect to power their Web3 experience. @WalletConnect on X and Telegram or visit https://WalletConnect.Network -- Timestamps: (00:00) Introduction  (00:40) Crypto's Leverage Unwind In 2021-22 (08:41) The Terra/Luna Fallout (14:30) Ad ZKSync (15:35) What We Learned From Last Cycle (19:11) Who Are The Big Lenders In This Cycle? (23:32) Ad ZKSync (24:37) Token Generation Events (31:02) Will Institutions Start Lending In Crypto? (35:08) Ads (Token.com. Bitwise, WalletConnect) (37:22) What Is Membrane? (48:40) Over vs Under Collateralized Lending (58:22) What Will Blow Up This Cycle? -- Disclaimer: Nothing said on Empire is a recommendation to buy or sell securities or tokens. This podcast is for informational purposes only, and any views expressed by anyone on the show are solely our opinions, not financial advice. Santiago, Jason, and our guests may hold positions in the companies, funds, or projects discussed.

  Hey there, Sales Leaders and Professionals! Imagine a surprising twist in the world of sales culture that could skyrocket your team's performance. It's something unexpected, something that will make you rethink everything you know about building a winning sales culture. Stay tuned to find out what it is and how it can revolutionize your team's success. Ready to take your sales game to the next level? Let's dive in! Cultivating a sales culture Cultivating a strong sales culture is essential for fostering teamwork, accountability, and continuous improvement within sales teams. It involves creating a supportive environment where team members are empowered to collaborate, learn from each other, and strive for excellence. A positive sales culture boosts morale, increases motivation, and ultimately leads to enhanced performance and success. This is Paul Fuller's story: In this episode of The Modern Selling Podcast, Mario Martinez Jr. sits down with Paul Fuller, the Chief Revenue Officer of Membrain, a B2B growth platform. Paul brings over two decades of sales experience to the table, making him an expert in driving sales culture through character, competence, and technology. He emphasizes the significance of continuous training, individual accountability, and celebrating wins while coaching privately for improvements, laying the foundation for a positive sales culture. Throughout the episode, Paul shares valuable insights on providing constructive criticism in sales, the challenges of implementing sales technology, and the importance of proper training and enablement. With his deep understanding of the multi-faceted nature of sales and the impact of technology on driving sales culture, Paul offers practical advice to enhance team collaboration, accountability, and sales excellence. This engaging conversation is a must-listen for sales leaders and professionals looking to elevate their team's performance and build a strong sales culture. Paul Fuller found his calling in sales through a journey filled with diverse experiences. His career, which includes founding a sales-as-a-service company and transitioning to his current role, reflects his unwavering dedication to the industry. Paul's view of sales as a blend of leadership, service, and wayfinding sheds light on the profound insights he has gained over the years. His story is not just about professional growth, but a testament to how a shift in mindset can turn disdain for a profession into a deep-rooted passion. Paul's narrative resonates with the challenges and triumphs many professionals encounter, making his journey an inspiration for those seeking fulfillment and purpose in their careers. I think the biggest thing that we can help them do is be good at their job and be held accountable to doing it well. - Paul Fuller Our special guest is Paul Fuller Paul Fuller, the Chief Revenue Officer of Membrain, is a seasoned sales professional with over 22 years of industry experience. With a track record of leading a sales-as-a-service company and now steering Membrane's B2B growth, Paul brings a wealth of expertise to the table. His unique journey from initial skepticism about sales to recognizing its potential to transform lives gives him a distinct outlook on building a sales culture within teams. Paul's insights into leadership, service, and wayfinding in sales offer a refreshing and valuable perspective for sales leaders and professionals seeking to enhance team performance and foster a collaborative and accountable sales culture. In this episode, you will be able to: Mastering LinkedIn messaging will revolutionize your sales outreach. Weekly sales reports can uncover hidden opportunities and boost team performance. Cultivating a sales culture within your team is key to achieving sales excellence. Choosing the right sales technology can supercharge your team's productivity. Effective B2B sales coaching strategies can transform your team's performance.   The key moments in this episode are: 00:00:00 - Importance of LinkedIn messaging and leadership in sales 00:01:56 - Introduction to Membrain and Paul Fuller 00:03:13 - Membrain's B2B growth platform 00:07:43 - Personal definition of sales and its impact on people 00:11:20 - Delicate communication in addressing areas of improvement 00:13:47 - Building a Strong Sales Culture Based on Character and Competence 00:16:31 - Accountability and Approach in Sales Leadership 00:21:03 - Creating a Systematic Sales Culture 00:23:15 - Equipping Sales Teams with the Right Technology 00:27:55 - The Pitfalls of Misguided Enablement 00:42:35 - Challenges in Training 00:43:20 - Resistance to Change 00:44:50 - Impact of Membrain 00:49:13 - Connecting with Paul 00:50:52 - All-Time Favorite Movie Timestamped summary of this episode: 00:00:00 - Importance of LinkedIn messaging and leadership in sales The conversation starts with a discussion about the missed opportunity to reply on LinkedIn messaging and then delves into the importance of leadership in sales and the need for delicate communication in addressing areas of improvement. 00:01:56 - Introduction to Membrain and Paul Fuller Mario introduces Paul Fuller, the Chief Revenue Officer of Membrain, and they discuss Paul's background in sales and his role at Membrain. 00:03:13 - Membrain's B2B growth platform Paul explains that Membrain offers a B2B growth platform that includes a CRM and is designed to help sales experts and their customers define and execute their sales processes and methodologies. 00:07:43 - Personal definition of sales and its impact on people Paul shares his personal definition of sales as leadership, service, and wayfinding, emphasizing the impact of sales on changing people's lives beyond just financial gain. 00:11:20 - Delicate communication in addressing areas of improvement The conversation explores the challenge of providing constructive criticism in sales and the importance of building respect and trust to effectively communicate areas of improvement to sales professionals. 00:13:47 - Building a Strong Sales Culture Based on Character and Competence Paul emphasizes the importance of character and competence in building a strong sales culture. He stresses the need for true intentions and a heart of servitude in sales interactions. 00:16:31 - Accountability and Approach in Sales Leadership The discussion shifts to the approach and accountability in sales leadership. Paul talks about the importance of holding individuals accountable for their actions and celebrating wins while providing private coaching for improvement. 00:21:03 - Creating a Systematic Sales Culture Paul discusses the significance of creating a systematic approach to building a sales culture. He emphasizes the need for continual training, coaching, and the use of technology to enable sales teams to be effective in their roles. 00:23:15 - Equipping Sales Teams with the Right Technology The conversation delves into the importance of providing sales teams with the right tools and technology. Paul highlights the demoralizing effect of not arming teams with the right technology and emphasizes the need to align technology with the desired sales outcomes. 00:27:55 - The Pitfalls of Misguided Enablement The discussion covers the misconception of enabling sales teams with technology without understanding the specific job roles and desired outcomes. Paul emphasizes the need to avoid the "tech confusion gap" and align technology with the specific needs of each sales role. 00:42:35 - Challenges in Training Paul discusses the challenges he faced in training a large number of people and the lack of implementation and engagement from the trainees. 00:43:20 - Resistance to Change Paul addresses the resistance to change from the sales team, including their reluctance to use referrals and their low open rates and engagement on emails. 00:44:50 - Impact of Membrain Paul talks about the impact of Membrain on the market, including elevating the sales profession, driving excellence in the sales process, and achieving significant growth and client retention. 00:49:13 - Connecting with Paul Paul shares that the best way to connect with him is through LinkedIn and also mentions his podcast, "The Art and Science of Complex Sales." 00:50:52 - All-Time Favorite Movie In a lighthearted moment, Paul reveals that his all-time favorite movie is "The Goonies" and shares a fun memory related to it. Mastering LinkedIn messaging Mastering LinkedIn messaging is crucial for building connections and generating leads in the digital sales landscape. It involves crafting personalized messages that resonate with prospects and drive engagement. By harnessing the power of LinkedIn, sales professionals can reach a wider audience and establish meaningful relationships with potential clients. Unveiling the benefits of weekly sales reports Weekly sales reports offer valuable insights into team performance, allowing sales leaders to track progress, identify areas for improvement, and celebrate achievements. These reports provide a clear overview of key metrics, such as revenue goals, conversion rates, and pipeline growth, enabling data-driven decision-making. By analyzing weekly sales reports, teams can optimize strategies, enhance efficiency, and drive sales success. The resources mentioned in this episode are: Connect with Paul Fuller on LinkedIn by searching for Paul Fuller, Membrain or visiting LinkedIn.com/in/paulsfuller. Check out the Art and Science of Complex Sales podcast created by Membrain, available on all podcast platforms. Download FlyMSG at flymsg.io to save 20 hours or more in a month and increase productivity with a free text expander and personal writing assistant. Visit Membrain's website at membrane.com to learn more about their B2B growth platform and how it can help elevate the sales profession. Listen to the Modern Selling Podcast and give it a five-star rating and review on iTunes to support the show and help others discover valuable sales insights.

Commentary by Dr.  Jian'an Wang

In this week's episode the Powell men discuss the latest debacle at the White House. #JuliusOrange #MangoMussolini #Twitler #DonaldTrump and his minion, butt boy,  #JDVance decided that they wanted to engange in a #WWF style tag team of #VolodymyrZelensky . #America has jumped the shark. We're no longer leader of the free world. We're #PutinsBitch . In other news, Derek reports that the #economicboycott was in effect at the #CIAA tournament down in #Baltimore . #AndrewCuomo is back and running for #NYCMayor #NYCMayor2025 . 

Dr. Pol Boudes, CMO of Rectify Pharmaceutical, highlights the importance of membrane proteins, specifically the role transporters play in how cells interact with their environment. Rectify is working on developing positive functional modulators (PFM) to address diseases related to dysfunctional transporters the first being primary sclerosing cholangitis, a rare liver disease with no current treatment options. The PFM can potentially restore the normal function of transporters involved in bile composition and secretion, which are key mechanisms in PSC.   Pol explains, "So you have different types of membrane proteins, but what we're working with are called transporters, so they're proteins that are based on the membrane but channel components out and in the cells. So basically, it's a way for the cell to interact with its environment, and you have multiple types of transporter proteins. We're specifically working or started to work with one group of family of proteins that are called the ABC transporters. They're a very important function, and they can either be disrupted because there is a mutation in the protein, so it's a genetic disease, or they are potentially disrupted because there is just a functional deficit of this transporter. The protein is normal, but it's not functioning properly. So it's a functional deficit of what we call the wildtype protein." "So with the PFMs, what we're doing is to use small molecules that you can administer orally, and they bind to the transporter, and by doing so, they can modify the three-dimensional structure of the transporter and consequently the way this protein behaves within the cellular environment. So we correct the function of the transporter by changing the size, if you want, of the shape of the transporter. So we started to focus on this type of proteins and you have many potential diseases due to transporter deficit."  "We're focusing on one disease, liver disease. That's our lead PFM for a disease called primary sclerosing cholangitis, which is a disease of the liver. This very severe liver disease is also a disease that has no treatment available, which is a little bit frustrating because the progression of this disease leads to liver cirrhosis. And the only thing you can do at this stage is liver transplantation. As you might know, liver transplantation is problematic because it's a very complex process, it's also very expensive, and unfortunately, there is a shortage of transplants. So we're trying to address this problem." #RectifyPharma #PrimarySclerosingCholangitis #PSC #RareDisease #LiverDiseases #BileProduction #Transporters rectifypharma.com Download the transcript here

Dr. Pol Boudes, CMO of Rectify Pharmaceutical, highlights the importance of membrane proteins, specifically the role transporters play in how cells interact with their environment. Rectify is working on developing positive functional modulators (PFM) to address diseases related to dysfunctional transporters the first being primary sclerosing cholangitis, a rare liver disease with no current treatment options. The PFM can potentially restore the normal function of transporters involved in bile composition and secretion, which are key mechanisms in PSC.   Pol explains, "So you have different types of membrane proteins, but what we're working with are called transporters, so they're proteins that are based on the membrane but channel components out and in the cells. So basically, it's a way for the cell to interact with its environment, and you have multiple types of transporter proteins. We're specifically working or started to work with one group of family of proteins that are called the ABC transporters. They're a very important function, and they can either be disrupted because there is a mutation in the protein, so it's a genetic disease, or they are potentially disrupted because there is just a functional deficit of this transporter. The protein is normal, but it's not functioning properly. So it's a functional deficit of what we call the wildtype protein." "So with the PFMs, what we're doing is to use small molecules that you can administer orally, and they bind to the transporter, and by doing so, they can modify the three-dimensional structure of the transporter and consequently the way this protein behaves within the cellular environment. So we correct the function of the transporter by changing the size, if you want, of the shape of the transporter. So we started to focus on this type of proteins and you have many potential diseases due to transporter deficit."  "We're focusing on one disease, liver disease. That's our lead PFM for a disease called primary sclerosing cholangitis, which is a disease of the liver. This very severe liver disease is also a disease that has no treatment available, which is a little bit frustrating because the progression of this disease leads to liver cirrhosis. And the only thing you can do at this stage is liver transplantation. As you might know, liver transplantation is problematic because it's a very complex process, it's also very expensive, and unfortunately, there is a shortage of transplants. So we're trying to address this problem." #RectifyPharma #PrimarySclerosingCholangitis #PSC #RareDisease #LiverDiseases #BileProduction #Transporters rectifypharma.com Listen to the podcast here

On this week's episode of Critical Care Time, we sit down with two brilliant early-career ECMOlogists for an “intro-plus” to VV and VA ECMO. Not only do we cover the basics, but we couldn't help ourselves and went on some deep dives along the way that you guys will hopefully find interesting! With the help of our good friends Nick Villalobos and Kha Dinh, we review indications for ECMO, approaches to configuration and management, touch on some of the complications and… even spend some time demystifying the European unit for girth! We hope you guys will have as much fun listening to this as we did producing it. If so, leave us a review and let us know what you think! Hosted on Acast. See acast.com/privacy for more information.

Membrane entourant les poumons, la plèvre protège nos organes respiratoires du frottement contre la paroi thoracique. Pneumothorax, épanchement pleural et cancers, les maladies de la plèvre sont diverses.   Pr Louis-Jean Couderc, professeur de Pneumologie. Ancien Chef du service de Pneumologie de l'Hôpital Foch à Suresnes, en région parisienne    Retrouvez l'émission en intégralité iciPneumothorax et autres maladies de la plèvre

Membrane entourant les poumons, la plèvre protège nos organes respiratoires du frottement contre la paroi thoracique. Pneumothorax, épanchement pleural et cancers, les maladies de la plèvre sont diverses. Comment les diagnostiquer ? Quelle prise en charge pour ces différentes pathologies ?  Pr Louis-Jean Couderc, professeur de Pneumologie. Ancien Chef du service de Pneumologie de l'Hôpital Foch à Suresnes, en région parisienne   Pr Bernard N'goran Koffi, chef du service de Pneumologie du CHU de Cocody à Abidjan. Ex-président de la Société Africaine de Pneumologie de Langue Française (saplf). Ex-membre du Conseil d'administration de la Société de Pneumologie de Langue Française (splf). Ex-président de la Société Ivoirienne de Pneumologie (sipp). Membre de la Société de Pneumologie de Langue Française.  Programmation musicale :► CKay – Addicted► Patrick Watson, November Ultra – Silencio.

Membrane entourant les poumons, la plèvre protège nos organes respiratoires du frottement contre la paroi thoracique. Pneumothorax, épanchement pleural et cancers, les maladies de la plèvre sont diverses. Comment les diagnostiquer ? Quelle prise en charge pour ces différentes pathologies ?  Pr Louis-Jean Couderc, professeur de Pneumologie. Ancien Chef du service de Pneumologie de l'Hôpital Foch à Suresnes, en région parisienne   Pr Bernard N'goran Koffi, chef du service de Pneumologie du CHU de Cocody à Abidjan. Ex-président de la Société Africaine de Pneumologie de Langue Française (saplf). Ex-membre du Conseil d'administration de la Société de Pneumologie de Langue Française (splf). Ex-président de la Société Ivoirienne de Pneumologie (sipp). Membre de la Société de Pneumologie de Langue Française.  Programmation musicale :► CKay – Addicted► Patrick Watson, November Ultra – Silencio.

Send us a textThis episode is a little different than most. Instead of skipping this week, we decided to give you a short episode because we have some exciting news! Tune in to hear about, the hardest pack Jameson has ever made, stories from behind the scenes of our newest fabrics, as well as the details on our maker meet up next month. New Products: Shop the New Year New Gear Sale https://ripstopbytheroll.com/pages/new-year-new-gear-2025210D Venom™ Gridstop ECO  https://ripstopbytheroll.com/products/210d-venom-gridstop-eco?rfsn=7912242.9c073860.9 oz MEMBRANE 15 ECO Ripstop Nylon https://ripstopbytheroll.com/products/0-9-oz-membrane-15-ripstop-nylon-calendered-eco?rfsn=7912242.9c073865.1 oz Lycra PowerMeshhttps://ripstopbytheroll.com/products/lycra-powermesh?rfsn=7912242.9c073864.0 oz Pocket Meshhttps://ripstopbytheroll.com/products/4-0-oz-pocket-mesh?rfsn=7912242.9c07386Fan Mail Questions: Youtube link for Derrick Hansen episode https://www.youtube.com/watch?v=U8nJl4_n2k8Find Us on Social Media

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We can't believe we have arrived at the last episode of 2024! This year has brought so many incredible and empowering births. We loved hearing how each of you fought for your birth goals, magnified your voices, and showed your strength. In today's episode, Meagan sums up The VBAC Link's 2024 achievements and shares some of the exciting things she has in store for 2025. The VBAC Link Supportive Provider ListThe VBAC Link Doula DirectoryHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hey guys, it's Meagan. Guess what? Today is our last 2024 episode. I cannot believe it is the end of the year. I absolutely cannot believe it. It feels like just yesterday that we started doing two episodes a week, and here we are 11 months later. We started in February. You guys, it has been such a great year. We have had so many incredible episodes from placental abruption, faith over fear, breech VBACs, post-dates, what hospital policies mean,and National Midwifery Week. One of my favorites, well actually, two of my favorites because he came on twice, was Dr. Fox. We had Dr. Fox a couple of times. We've had doula tips from VBAC episodes. We've had some fun episodes where we've had some VBAC Link-certified doulas as cohosts. Oh my gosh, so many great things. I don't know if you noticed, but in October, we started doing a themed week. Every two episodes in one month was a theme. For October, we had midwifery. It was National Midwifery Week so we talked about midwives and the stats about midwives. We had CNM Paige come on with our very own Lily who talked more about midwifery care, what does it look like, how to choose, can a midwife support VBAC, and all of that fun, fun stuff. And then in November, it was Veteran's Day so we had some military mamas on there and more about how to navigate that. We talked a little bit about Tricare and tips about navigating birth as a servicemember or as a significant other. That was really, really fun.This month, we touched on uterine abnormalities. We had Flannery talking about her bicornuate uterus and more about specific types of uteruses and what that means. It's so weird to think, but there are different types of uteruses, you guys. That doesn't mean that if you have a different type of uterus that you can't VBAC. It may mean that you may be faced with some challenges like a breech baby or something like that, but we wanted to share more about that because that's not talked about. But it's not going to stop. We have got that coming all year. 2025 is going to have a lot of really fun, specific episodes. The reason why I did this is because I wanted to have a whole week in two episodes where people could come and just binge two specific episodes that they may be looking for. We have a lot of people writing in saying, “Hey, I'm looking for VBAC after multiple Cesareans. Hey, I'm looking for breech stories. Hey, I would like to hear more healing CBAC stories or planned Cesarean stories.” We wanted to have it so they could just do two episodes back to back.Then of course, there are episodes throughout the whole podcast that we have that you can go back and find, but this way, you can find it in one week, two episodes back to back. We've got things like CBAC coming, VBAC after multiple Cesareans. We've got breech. We've got OB week. That's going to be fun. Oh man, I'm trying to think. So many other things. Special scars. We have a special scars month. We are just going to have months where it's typically going to be that second week where it will be a specific theme and topic. Don't forget to check that out coming up in 2025. Like I said, we started that up in October. Okay, so some other really fun and exciting things coming up, I do have a surprise for you, but unfortunately, you're going to have to wait until 2025. I'm really excited for this series. Yeah. It's going to be so good. Make sure to come back next week in 2025 to learn more about a surprise that I have coming your way. Then, in addition to that surprise and our themed weeks, I'm actually going to be rebroadcasting some of our old episodes. As you know, we are getting up there. We are at 365 episodes today which is so dang exciting. I cannot thank you guys enough for continuing to support this podcast, for coming back, listening, downloading these episodes, and just being here with us. We see you in our community on Facebook. We see you on Instagram. We see you downloading and listening. We are getting messages in regards to these stories and how much they are connecting with people.You guys, these stories are incredible. Just a reminder also, we are always accepting submissions. Now, we can't get to every submission because we do get a lot of submissions which is so fun to go through. We share them on our social media if we can't sometimes share them on the podcast, but please, if you have a story that you would like to submit and share them with other Women of Strength who are coming after you and are wanting to hear these empowering messages, go to thevbaclink.com/share, I believe, and submit your podcast story. Okay, going back. We are rebroadcasting episodes. I have gone back and listened to probably 10 or 12 episodes. Some of our really, really amazing episodes, and I've found some nuggets after re-listening that I'm pulling through and giving tips. We're going to have extra tips, extra links, and also if there have been updated things or updated studies from 2018 that have now been updated, we want to make sure that we freshen up these episodes and bring them back to more recent episodes. If you have a favorite episode that you would like to hear rebroadcasted or one that you listen to on repeat, will you let us know? Email us at info@thevbaclink.com and let us know what your favorite episode is and why, or if you are looking for some more information or want us to elaborate more on a topic that maybe we have discussed but didn't go too far into detail that I can maybe go into deeper detail about. Okay, I'm trying to think, you guys. We've had so many amazing things this year. Blogs– we have been pumping out blogs like crazy. There are so many things from preparing for your VBAC, 5 things to do before you get pregnant, recovering from a Cesarean birth. You guys, if you've been with us for a while, you know we absolutely love and adore Needed. We wholeheartedly love and trust everything they produce. We love them. They have really been so gracious to offer us a wonderful 20% off discount code, so don't forget that. That is still valid. You can go to thisisneeded.com and type in VBAC20 and get 20% off your order. We talk more about why prenatal nutrition matters. We talk about creating your ideal hospital environment. We talk about C-section scar massage and why it's important. That is a big one that isn't talked about enough. We talk about hiring doulas, things to put on your registry, more about red raspberry leaf tea. We talk about heartburn, Tums, and also what else Tums can do to help us in our VBAC. So many things. We talk about positions and using the ball. Oh my gosh, just so many incredible things. We've got so many blogs coming at thevbaclink.com/blogs so make sure to check out the blog and learn more about these topics. Membrane sweeps, VBAC after multiple Cesareans, uterine rupture, if you're looking for that VBAC provider, definitely check out that blog about how to find out if you need to switch your provider. Then of course, we have our VBAC course. You guys, I love our course so much. Another big reason why we are going to be re-airing our episodes is so that we can keep updating our course. Birth in general is updating all of the time. This course– Julie and I created it a long time ago, and it is my baby. I am so excited for this course because I have seen so many people get the information that they need, feel more empowered and equipped to have a VBAC, then we actually have a birth worker course. The birth worker course is to certify VBAC doulas, our birth workers, and it is accredited. It is 8 ICEA credits, so if you have a doula that hasn't been in our course yet,  maybe suggest that to them or if you are a birth worker listening, I highly suggest it. We have a VBAC Link Doula directory, so if you are looking for a doula or, like I said, you are a birth worker and you want to be found, we want to help you be found. You can find a doula at thevbaclink.com/findadoula, and if you are a birth worker, you can check out your area. California, I know needs more doulas. Texas, there are a lot of states that need more doulas. We would love to add you to your family.Okay, you guys. I'm trying to think what else. Oh my gosh. I could not leave without saying this. This year, we updated our provider list. It is on Instagram. You can go the The VBAC Link at Instagram. Click on our linktree in our bio, and it is the top one to find a supportive provider in your area. Now, if you have a provider that should be on this list or if you are a provider and wantt o be on this list, please email us at info@thevbaclink.com or you can email us on Instagram so we can get your provider listed. We really need providers who accept VBAC after multiple Cesareans, breech VBAC, and who are just VBAC supportive in general. You guys, it is so stinking silly and stupid how hard it is to sometimes find a provider. Please check out that form. If your provider is supportive, please, please, please let us know so we can get them listed. Okay, you guys, I think that is about everything. It has been such a great 2024. I am so grateful again for you guys. I hope you will continue to join us for 2025 because we do have more incredible episodes coming your way from a lot of VBA2Cs. We have polyhydramnios (high fluid). We have HBACs. We have CBACs. We're going to have a couple of OBs actually and special scars. So many great things. We will catch you in 2025. I hope you guys have a fantastic new year. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

I read from ferry to fertilization membrane.     The word of the episode is "fertilization membrane". https://en.wikipedia.org/wiki/Vitelline_membrane     Use my special link https://zen.ai/thedictionary to save 30% off your first month of any Zencastr paid plan.    Create your podcast today! #madeonzencastr     Theme music from Jonah Kraut https://jonahkraut.bandcamp.com/     Merchandising! https://www.teepublic.com/user/spejampar     "The Dictionary - Letter A" on YouTube   "The Dictionary - Letter B" on YouTube   "The Dictionary - Letter C" on YouTube   "The Dictionary - Letter D" on YouTube   "The Dictionary - Letter E" on YouTube   "The Dictionary - Letter F" on YouTube     Featured in a Top 10 Dictionary Podcasts list! https://blog.feedspot.com/dictionary_podcasts/     Backwards Talking on YouTube: https://www.youtube.com/playlist?list=PLmIujMwEDbgZUexyR90jaTEEVmAYcCzuq     https://linktr.ee/spejampar dictionarypod@gmail.com https://www.facebook.com/thedictionarypod/ https://www.threads.net/@dictionarypod https://twitter.com/dictionarypod https://www.instagram.com/dictionarypod/ https://www.patreon.com/spejampar https://www.tiktok.com/@spejampar 917-727-5757

News includes the long-awaited release of Phoenix LiveView 1.0, exciting enhancements in Elixir 1.18 such as built-in JSON support and improved ExUnit testing capabilities, and the unveiling of AWS Aurora DSQL, a serverless distributed PostgreSQL-compatible database service. Lars Wikman joins us to share updates about Nerves, including the latest on Nerves Hub, Nerves Cloud, and his project oswag.org where you can find official Elixir and Nerves T-shirts. All this and more! Show Notes online - http://podcast.thinkingelixir.com/233 (http://podcast.thinkingelixir.com/233) Elixir Community News https://www.phoenixframework.org/blog/phoenix-liveview-1.0-released (https://www.phoenixframework.org/blog/phoenix-liveview-1.0-released?utm_source=thinkingelixir&utm_medium=shownotes) – Phoenix LiveView 1.0 was officially released! https://github.com/phoenixframework/phoenixliveview (https://github.com/phoenixframework/phoenix_live_view?utm_source=thinkingelixir&utm_medium=shownotes) – Access the Phoenix LiveView 1.0 source code on GitHub. https://github.com/phoenixframework/phoenixliveview/blob/main/CHANGELOG.md (https://github.com/phoenixframework/phoenix_live_view/blob/main/CHANGELOG.md?utm_source=thinkingelixir&utm_medium=shownotes) – Check out the changelog for Phoenix LiveView 1.0. https://dockyard.com/blog/2024/12/03/phoenix-liveview-goes-1-0 (https://dockyard.com/blog/2024/12/03/phoenix-liveview-goes-1-0?utm_source=thinkingelixir&utm_medium=shownotes) – Dockyard blog discussing Phoenix LiveView 1.0. The 1.0 release was announced the day after our last episode was recorded. https://elixirforum.com/t/phoenix-liveview-1-0-is-out/67863 (https://elixirforum.com/t/phoenix-liveview-1-0-is-out/67863?utm_source=thinkingelixir&utm_medium=shownotes) – ElixirForum discussion on the release of Phoenix LiveView 1.0. https://x.com/chris_mccord/status/1864067247255306332 (https://x.com/chris_mccord/status/1864067247255306332?utm_source=thinkingelixir&utm_medium=shownotes) – Chris McCord's announcement of the Phoenix LiveView 1.0 release on Twitter/X. You can now quickly get started with Elixir and Phoenix using a single command line installer. http://elixir-install.org/ (http://elixir-install.org/?utm_source=thinkingelixir&utm_medium=shownotes) – Wojtek Mach's work on a one-line Elixir installer made getting started with Phoenix easier. https://x.com/chris_mccord/status/1864067249960558617 (https://x.com/chris_mccord/status/1864067249960558617?utm_source=thinkingelixir&utm_medium=shownotes) – Chris McCord credits Wojtek Mach for his work on the Elixir installer. https://x.com/liveviewnative/status/1864088172570857691 (https://x.com/liveviewnative/status/1864088172570857691?utm_source=thinkingelixir&utm_medium=shownotes) – LiveView Native updated to be based on LiveView 1.0. https://github.com/liveview-native/liveviewnative/commit/5077bda7bf999311bee467828390912e03e74467 (https://github.com/liveview-native/live_view_native/commit/5077bda7bf999311bee467828390912e03e74467?utm_source=thinkingelixir&utm_medium=shownotes) – GitHub commit showing updates on LiveView Native for LiveView 1.0 compatibility. Elixir 1.18 is confirmed to be released soon, bringing significant improvements. https://github.com/elixir-lang/elixir (https://github.com/elixir-lang/elixir?utm_source=thinkingelixir&utm_medium=shownotes) – Elixir's GitHub repository where you can find version 1.18. https://github.com/elixir-lang/elixir/blob/v1.18/CHANGELOG.md (https://github.com/elixir-lang/elixir/blob/v1.18/CHANGELOG.md?utm_source=thinkingelixir&utm_medium=shownotes) – The changelog details for Elixir 1.18, featuring many new enhancements. New built-in JSON support and upgrades to the testing library in Elixir 1.18. Type system in Elixir 1.18 now supports type checking of function calls. ExUnit in Elixir 1.18 supports parameterized tests and better concurrency handling. mix format --migrate in Elixir 1.18 helps to update deprecated constructs. Official JSON module in Elixir provides standards-compliant encoding and decoding. Language server improvements in Elixir 1.18 enhance development experience. Potential minor incompatibilities in Elixir 1.18, but mostly due to better error detection. https://github.com/nerves-hub/nerveshubweb/releases/tag/v2.1.0 (https://github.com/nerves-hub/nerves_hub_web/releases/tag/v2.1.0?utm_source=thinkingelixir&utm_medium=shownotes) – Nerves Hub 2.1.0 has been released with various updates. https://github.com/nerves-hub/nerveshublink/releases/tag/v2.6.0 (https://github.com/nerves-hub/nerves_hub_link/releases/tag/v2.6.0?utm_source=thinkingelixir&utm_medium=shownotes) – Version 2.6.0 of Nerves Hub Link is now available with new features. Nerves Hub now supports extensions and improved functionality. https://blog.swmansion.com/elixir-stream-week-how-not-to-load-test-during-a-live-elixir-run-broadcast-watched-by-hundreds-of-217d8f4b957a (https://blog.swmansion.com/elixir-stream-week-how-not-to-load-test-during-a-live-elixir-run-broadcast-watched-by-hundreds-of-217d8f4b957a?utm_source=thinkingelixir&utm_medium=shownotes) – Membrane's write-up on Elixir Stream Week and related technical challenges. https://x.com/astuyve/status/1863992458637680935 (https://x.com/astuyve/status/1863992458637680935?utm_source=thinkingelixir&utm_medium=shownotes) – Discussion on Twitter/X about AWS Aurora DSQL, a new distributed SQL service. https://aws.amazon.com/rds/aurora/dsql/ (https://aws.amazon.com/rds/aurora/dsql/?utm_source=thinkingelixir&utm_medium=shownotes) – AWS Aurora DSQL is a new serverless, distributed PostgreSQL-compatible database service. Do you have some Elixir news to share? Tell us at @ThinkingElixir (https://twitter.com/ThinkingElixir) or email at show@thinkingelixir.com (mailto:show@thinkingelixir.com) Discussion Resources - https://docs.nerves-hub.org/ (https://docs.nerves-hub.org/?utm_source=thinkingelixir&utm_medium=shownotes) - https://nerves-project.org/ (https://nerves-project.org/?utm_source=thinkingelixir&utm_medium=shownotes) - https://github.com/nerves-project (https://github.com/nerves-project?utm_source=thinkingelixir&utm_medium=shownotes) - https://nervescloud.com/ (https://nervescloud.com/?utm_source=thinkingelixir&utm_medium=shownotes) - https://www.yoctoproject.org/ (https://www.yoctoproject.org/?utm_source=thinkingelixir&utm_medium=shownotes) - https://oswag.org/ (https://oswag.org/?utm_source=thinkingelixir&utm_medium=shownotes) – Buy an official Elixir t-shirt! Guest Information - https://bsky.app/profile/lawik.bsky.social (https://bsky.app/profile/lawik.bsky.social?utm_source=thinkingelixir&utm_medium=shownotes) – on Bluesky - https://github.com/lawik (https://github.com/lawik?utm_source=thinkingelixir&utm_medium=shownotes) – on Github - https://fosstodon.org/@lawik (https://fosstodon.org/@lawik?utm_source=thinkingelixir&utm_medium=shownotes) – on Fediverse - https://underjord.io/ (https://underjord.io/?utm_source=thinkingelixir&utm_medium=shownotes) – Blog Find us online - Message the show - Bluesky (https://bsky.app/profile/thinkingelixir.com) - Message the show - X (https://x.com/ThinkingElixir) - Message the show on Fediverse - @ThinkingElixir@genserver.social (https://genserver.social/ThinkingElixir) - Email the show - show@thinkingelixir.com (mailto:show@thinkingelixir.com) - Mark Ericksen on X - @brainlid (https://x.com/brainlid) - Mark Ericksen on Bluesky - @brainlid.bsky.social (https://bsky.app/profile/brainlid.bsky.social) - Mark Ericksen on Fediverse - @brainlid@genserver.social (https://genserver.social/brainlid)

Differences in ion concentrations inside and outside a cell cause a difference in the charge of the intracellular and extracellular environments. This electrical polarization of a cell relative to its environment is referred to as cellular membrane potential. This potential serves as an energy source for a variety of cellular functions and as a way for excitable cells like muscle cells and neurons to communicate their signals. A cell controls its membrane potential by regulating the concentration of multiple ions and other charged particles. Let's take a closer look at the biochemistry behind the cell membrane potential. After listening to this AudioBrick, you should be able to: Define equilibrium and describe the forces at work on ions across a biological membrane. Discuss the importance of the Nernst equation and equilibrium potentials. Describe the importance of Na-K-ATPase in relation to the resting membrane potential (Vr). Describe the nonequilibrium steady-state (NESS). Define and discuss the chord conductance equation. You can also check out the original brick from our Cellular Biology collection, which is available for free. Learn more about Rx Bricks by signing up for a free USMLE-Rx account: www.usmle-rx.com You will get 5 days of full access to our Rx360+ program, including nearly 800 Rx Bricks.  After the 5-day period, you will still be able to access over 150 free bricks, including the entire collections for General Microbiology and Cellular and Molecular Biology. *** If you enjoyed this episode, we'd love for you to leave a review on Apple Podcasts.  It helps with our visibility, and the more med students (or future med students) listen to the podcast, the more we can provide to the future physicians of the world. Follow USMLE-Rx at: Facebook: www.facebook.com/usmlerx Blog: www.firstaidteam.com Twitter: https://twitter.com/firstaidteam Instagram: https://www.instagram.com/firstaidteam/ YouTube: www.youtube.com/USMLERX Learn how you can access over 150 of our bricks for FREE: https://usmlerx.wpengine.com/free-bricks/

References Nature 2024. volume 635, pages 1010–1018 Hunter-Garcia. 1975. "Cruel White Water" https://youtu.be/T-oBD3F74Nk?si=7--mnhOeZlwW_pHf Simon, P. 1964. "Sounds of Silence" on Wednesday Morning 3AM. LP https://youtu.be/4fWyzwo1xg0?si=uEeoFcIvILUAEZqa Vivaldi,A. 1713. Gloria . https://youtu.be/OvZYhxT5Mf8?si=e9-Pi_HAQgtfSkqA --- Support this podcast: https://podcasters.spotify.com/pod/show/dr-daniel-j-guerra/support

This week, Scott was joined by his Lawfare colleagues Eric Ciaramella and Anastasiia Lapatina, as well as special guest Kyiv Independent reporter Francis Farrell, for an episode committed to one big topic: what Trump's return to the White House might mean for Ukraine. They tackled the issue in three parts:“What Condition My Attrition Is In.” By most accounts, after more than two years of fighting, the conflict in Ukraine has come to look very much like a war of attrition. How do Ukrainians feel about the state of the conflict and the prospects looking forward? What steps are the outgoing Biden administration taking to change the calculus—and what impact might they still have, if any?“New Boss, Same as the Old Boss.” Donald Trump's return to the White House promises a sea change in how the United States has approached the conflict in Ukraine. What do his early national security appointments—and engagements with, among others, Ukrainian President Volodymyr Zelensky—tell us about his plans? And where do they seem likely to lead?“Flipping the Board.” Trump's election—and whatever outcome he is able to bring about in Ukraine—has the potential to reset the strategic environment in Europe (and the U.S. strategic relationship with Russia) more generally. What might regional security—and security for Ukraine specifically—look like by 2028?For object lessons, Nastya recommended Catherine Belton's new book, “Putin's People,” on the return and rise to power of the KGB. Eric gave a belated endorsement for the Oscar-winning South Korean film “Parasite,” and urged folks to watch it as a celebration of the democratic resilience South Korea demonstrated this week. Scott plugged the holiday variety show he was attending that evening and urged listeners to welcome the season with Aimee Mann's “One More Drifter in the Snow.” And Francis recommended GeoGuessr, the geolocation game that has taken the KI newsroom by storm.Rational Security will be saying goodbye to 2024 in its traditional fashion: by discussing listener-submitted topics and object lessons! To submit yours, call in to (202) 743-5831 to leave a voicemail or email rationalsecurity@lawfaremedia.org. Just do it by COB on December 18!To receive ad-free podcasts, become a Lawfare Material Supporter at www.patreon.com/lawfare. You can also support Lawfare by making a one-time donation at https://givebutter.com/lawfare-institute.Support this show http://supporter.acast.com/lawfare. Hosted on Acast. See acast.com/privacy for more information.

This week, Scott was joined by his Lawfare colleagues Eric Ciaramella and Anastasiia Lapatina, as well as special guest Kyiv Independent reporter Francis Farrell, for an episode committed to one big topic: what Trump's return to the White House might mean for Ukraine. They tackled the issue in three parts:“What Condition My Attrition Is In.” By most accounts, after more than two years of fighting, the conflict in Ukraine has come to look very much like a war of attrition. How do Ukrainians feel about the state of the conflict and the prospects looking forward? What steps are the outgoing Biden administration taking to change the calculus—and what impact might they still have, if any?“New Boss, Same as the Old Boss.” Donald Trump's return to the White House promises a sea change in how the United States has approached the conflict in Ukraine. What do his early national security appointments—and engagements with, among others, Ukrainian President Volodymyr Zelensky—tell us about his plans? And where do they seem likely to lead?“Flipping the Board.” Trump's election—and whatever outcome he is able to bring about in Ukraine—has the potential to reset the strategic environment in Europe (and the U.S. strategic relationship with Russia) more generally. What might regional security—and security for Ukraine specifically—look like by 2028?For object lessons, Nastya recommended Catherine Belton's new book, “Putin's People,” on the return and rise to power of the KGB. Eric gave a belated endorsement for the Oscar-winning South Korean film “Parasite,” and urged folks to watch it as a celebration of the democratic resilience South Korea demonstrated this week. Scott plugged the holiday variety show he was attending that evening and urged listeners to welcome the season with Aimee Mann's “One More Drifter in the Snow.” And Francis recommended GeoGuessr, the geolocation game that has taken the KI newsroom by storm.Rational Security will be saying goodbye to 2024 in its traditional fashion: by discussing listener-submitted topics and object lessons! To submit yours, call in to (202) 743-5831 to leave a voicemail or email rationalsecurity@lawfaremedia.org. Just do it by COB on December 18!To receive ad-free podcasts, become a Lawfare Material Supporter at www.patreon.com/lawfare. You can also support Lawfare by making a one-time donation at https://givebutter.com/lawfare-institute. Hosted on Acast. See acast.com/privacy for more information.

CHEST December 2024, Volume 166, Issue 6 Elias H. Pratt, MD, joins CHEST® Journal Podcast Moderator Alice de Gallo Moraes, MD, to discuss his research exploring whether implementation of different institutional RBC transfusion thresholds for patients receiving venovenous ECMO is associated with changes in RBC use and patient outcomes. DOI: 10.1016/j.chest.2024.05.043   Disclaimer: The purpose of this activity is to expand the reach of CHEST content through awareness, critique, and discussion. All articles have undergone peer review for methodologic rigor and audience relevance. Any views asserted are those of the speakers and are not endorsed by CHEST. Listeners should be aware that speakers' opinions may vary and are advised to read the full corresponding journal article(s) for complete context. This content should not be used as a basis for medical advice or treatment, nor should it substitute the judgment used by clinicians in the practice of evidence-based medicine.

In this episode, Dr. Cremers dives deep into the world of ocular health, exploring the causes, symptoms, and treatment options for Corneal Dystrophy: Map-dot- fingerprint aka anterior basement membrane dystrophy (ABMD). This episode provides valuable insights into maintaining corneal health and preventing recurring issues.

Today's podcast comes from this blog post: The Mighty Cell Membrane Discover more Christian podcasts at lifeaudio.com and inquire about advertising opportunities at lifeaudio.com/contact-us.

 The FHB crew talks about hunting down noisy insect, the pros and cons of rubber and PVC roofs and insulating them without creating problems. They also discuss insulating and waterproofing stone foundations. Tune in to Episode 658 of the Fine Homebuilding Podcast to learn more about:  A simple method for catching indoor crickets Insulation strategies for EPDM and PVC membrane roofs How to install insulation on a stone foundation  Have a question or topic you want us to talk about on the show? Email us at fhbpodcast@taunton.com.     ➡️ Check Out the Full Show Notes: FHB Podcast 658 ➡️ Learn about SketchUp for Builders by Jon Beer, the new E-learning course from Fine Homebuilding ➡️ Follow Fine Homebuilding on Social Media:   Instagram • Facebook • TikTok • Pinterest • YouTube  ⭐⭐⭐⭐⭐  If you enjoy the show, please subscribe and rate us on iTunes, Spotify, YouTube Music, or wherever you prefer to listen.

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On today's episode I am sitting down solo to share the candid details of my birth story of my beautiful daughter Amelia! I wanted to share my birth story alongside some details of my early days postpartum because when I was about to go through this experience, it was so hard to find podcast episodes and information like this of women who had hospital births, opted for an epidural and also an induction. And because I had a positive experience, I wanted to share exactly what it was like with you! This is a very special episode as I recount the raw emotions starting at 39 weeks pregnant leading up to Amelia's delivery, what I've learned about motherhood thus far and the unexpected things I've learned during this incredibly transformative time. I hope my story resonates and sheds light on the diverse and extraordinary experience of childbirth. To connect with Lauren, click HERE  Submit your question for advice from Lauren on the show HERE  Take the free Weight Loss Personality Quiz HERE  Shop Our Meal Plans HERE  Get Support & Personally Work With Us HERE  Related Episodes:

On this episode we dive into the culture around selling PVC successfully.  Join us as we cover the reasons owners select a roofing system, strategies for identifying projects that specify PVC, how contractors can successfully install JM PVC on roofs, and the importance of relationships in building the PVC pipeline​​​. 

Katie is a newborn and family photographer based out of Chicago. After going through IVF, Katie was surprised to find out that her first pregnancy was with identical twins. At 33 weeks, she had an unexpected bleed and then another at 35 weeks. Because of placental abruption, she went straight to a Cesarean and her babies were in the NICU for 7 days.Katie wanted to know what a singleton pregnancy and VBAC birth could be like. She found a supportive midwife group through her local ICAN chapter that had around a 90% VBAC success rate! She also hired a doula. As her due date approached, Katie decided to opt for membrane sweeps to avoid a medical induction starting at 38+6 weeks.After four membrane sweeps over the course of two weeks, spontaneous labor began. She arrived at the hospital and her sweet baby was born vaginally just 5 hours later!Though she said she has a low pain tolerance, Katie's VBAC was unmedicated and she also shares her experience with a retained placenta and a second-degree tear. Katie, that is no small feat-- we know you are an absolute warrior and woman of strength!How to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Welcome to the show, Katie. Thank you so much for being here with us. You guys, Katie is from Chicago, right? Chicago. Katie: Yep. Meagan: She is an IVF mama. She's got three girls. She is a girl mom and two identical twins and then a baby girl. How old is your baby girl now? Katie: She's going to be 3 months tomorrow. Meagan: 3 months so still little tiny. Oh my gosh. I love it. So yeah, and then you guys, when she's not doing the mom thing with all of her girls, she is also a newborn and family photographer which is awesome. Can you share with us your handle so we can come follow you?Katie: Yeah. On Instagram, I'm at katiemichellestudios. Meagan: Okay, katiemichellestudios and we are going to make sure to have that in the show notes so you can go follow her and follow her amazing work. And if you're in Chicago and you need newborn or family photos, hit her up. Is there a specific– Chicago is big. Is there a specific area that you serve?Katie: I'm in the northwest suburbs but I do in-home sessions wherever. I use a studio in Oak Park. Meagan: Okay, awesome. Then with your stories today, we've got a couple of highlights. We have IVF, placental abruption, and sticky placenta. I'm excited to talk about sticky placenta for sure because it's not something a lot of people talk about that could happen. Then, of course, the twins and all of that. We are going to get into that but I do have a Review of the Week. You guys, I know every single week I know you are probably sick of me asking but I love your reviews. Thank you so much for your reviews and remember, we always accept your reviews. Okay, this is from cassie80. It says, “Extremely educational and super empowering.” It says, “After a traumatic C-section in 2016, on my research journey about VBAC, I came across this podcast and instantly fell in love.” You guys, that just says something to me. 2016 is when she had her C-section and 2018 is when this podcast started. It's crazy to think that it's been going for so long but I'm so grateful for all of you guys sharing your stories like you, Ms. Katie, and helping this continue. It says, “I am currently trying for number two and am on a mission to VBAC. Hearing all of these wonderful stories of strength has given me the confidence that I can do it when the time comes. You and all of the women who courageously share their stories are just amazing. You all provide healing and support for all of us mamas.” Thank you so much, Cassie, and I'm so glad that you are here with us and have been with us for so long. Okay, Katie. Thank you again for being here. Katie: Thank you so much. I am so excited to be on this podcast myself because I listened to you guys nonstop my entire pregnancy even before and I always had it in the back of my mind that, Oh, if I get my VBAC, I'm going to come on here and tell my story. I am super excited and thank you for having me. Meagan: Oh my gosh, thank you so much. Let's talk about these twins. Let's talk about that birth. Katie: Yes. They were IVF but they were obviously surprise identical twins. My embryo split into obviously identical twins but they were an interesting pregnancy because usually with IVF, the twins are mono-di which means they share a placenta and have two sacs but my girls are actually di-di so they had two placentas, two sacs, so that meant they were a little bit less of a risky pregnancy and a vaginal birth was a possibility. That's what I was planning on. Everything was pretty smooth up until 33 weeks which is when I had my first bleed. It was just the middle of the night. I got up and I just started gushing. The doctor said that it was a marginal placental abruption. That means it was on the edge of the placenta and it wasn't a risk to them. Obviously, it was super scary. I thought that I was going to lose them both but everything with them was fine. They sent me home after a few days at the hospital. They just told me to take it easy, but they said it might happen again. It did at 35 weeks and 3 days. I had another bleed. At that point, they said, “They are almost to term for twins.” It's technically 37 or 38 weeks is when they like to induce for twins so they just said not to risk going any further and let's just get them out right now. I was planning on a vaginal birth, but because of that abruption and we didn't know what state the placenta was in and what would happen if there was an induction process that was started, so with the doctors, we decided I didn't want to risk induction and then needing a C-section anyway for the other twin so we did the C-section. It was a really, really rough recovery and they were in the NICU for a week. One of them needed breathing support and the other one was there for growing and feeding. Meagan: How big were they?Katie: 5 pounds, 3 ounces, and 4 pounds, 13 ounces. Meagan: Okay, okay. Katie: They were a good size. They were overall healthy but it was for me, super duper rough as a first-time mom to twins especially. The breastfeeding journey was really hard. I dealt with low milk supply and they were so tiny that it was hard for them to latch so I ended up exclusively pumping for 11 months. That's their story. Meagan: Wow. That's a lot of work by the way for someone maybe who hasn't pumped a lot. Holy cow. Good job. Katie: Yeah. So when we decided to have a third which was a tough decision for us, my husband was not on board. We ended up deciding that we wanted to experience what it's like to have a singleton baby and just having a singleton pregnancy hopefully and a VBAC. I definitely knew that I wanted a VBAC and started doing all my research. I found a very VBAC-supportive midwife group in my area. They have a 90-something percent VBAC rate in the hospital which is crazy. Meagan: Wow, yeah. That's amazing. What do you think they do so differently that a lot of other groups don't do that makes them so successful? Or are you going to share about it?Katie: I'm not sure. I think the hospital might be part of it, like the hospital policies might be more supportive. They deliver at Evanston Hospital if anyone is interested. Overall, I think the doctors that they work with because it's a midwife group that they work alongside doctors that when there is a delivery for the midwives, the doctors are also in the hospital. I think the doctors are also very VBAC-supportive so I think that helps when they are working together. Meagan: Yes, absolutely. Katie: That's that story. Meagan: So you found them. You found the providers. Did you go and ask them questions? How did you feel like you realized that they were supportive? Katie: Yeah. I went on– what's that group that have a Facebook group all around the country for different areas about lowering the C-section rate?Meagan: Oh, cesareanrates.org? Katie: I'm not sure. They are an organization. Meagan: Oh, ICAN?Katie: ICAN, yes. I went on my local Facebook group for ICAN and I asked around. I got their info. I first went for an appointment with one of the doctors at that practice before I was even pregnant because I was planning for the transfer and I liked that doctor, but then I realized that they have midwives and people really raved about the midwives. They said if you are looking for a more holistic experience and they spend more time with you than the doctors do. I just decided to go that route and somehow picking the midwives made me dive into the whole unmedicated birth side of things as well. I ended up hiring a doula as well. I never thought I'd be someone interested in unmedicated birth. I consider myself to have very low pain tolerance. Meagan: So tell us more about the birth. You have a low pain tolerance but you did go unmedicated?Katie: Yes. I ended up doing it. Meagan: Okay. Did you go into spontaneous labor?Katie: Yeah, it was interesting. I ended up having four membrane sweeps which is not that spontaneous. Meagan: Well, hey. This is the thing. A lot of people ask about membrane sweeps and sometimes people feel, Hey, this is worth it. Let's do this. Some people don't. Sometimes it works and sometimes it takes many and sometimes it doesn't. It's whatever feels right. So do you remember where you were with the first membrane sweep cervical-wise and how many weeks and things like that? Katie: Yeah, so I wanted to start them. Remember, I had never been pregnant past 35 weeks. Meagan: Right, yeah. Katie: I really thought that I was going to have an early baby again, but that really wasn't the case. I had her at 40 and 5. So the membrane sweep, I started the first one at 38 and 6 so basically at my 39-week appointment. I had no change after that one. Nothing happened. That's kind of what I assumed would happen so I had another one the next week at 39 and 6 and at that point, I was 2 centimeters, 80% effaced, and -1 station. Meagan: Okay, so pretty good cervical statistics there for a membrane sweep. Katie: Yeah. So then it was my due date and I was starting to feel more pressure. The mucus plug was coming out and baby was acting super active which I heard can happen close to when a baby is ready to be born but nothing really happened at that point. So then I decided to get my third sweep. I think that was 40+2 and at that point, I was 2.5 centimeters but the same for everything else. But things were starting to happen. I was having more stuff come out and I was like, Oh my gosh. How much longer am I going to be pregnant? Meagan: I'm sure. This is the thing. When you had either preterm or just early deliveries before and then you go past that, it feels like, No. I cannot be pregnant longer than this. This is eternity. Katie: Yes. It was really hard because I had the two-year-old twins also. It was getting to be a real mental and physical struggle. Meagan: Yes. Yeah. Katie: Also, I was doing pumping to try to induce labor and that wasn't doing anything. Meagan: Yeah. Was it causing contractions at all or was it just causing them and then you'd stop and it would stop?Katie: Yeah, basically it would just cause the Braxton Hicks contractions and nothing else. Meagan: Then it would go away. Katie: Yeah. So I had my third sweep and that one really started to do something because I went into prodromal labor which was a doozy. Meagan: Yeah. You know, that can be a risk of trying a membrane sweep. It can cause some prodromal labor but again, a lot of the time, prodromal labor still does stuff. It's tiring and it's exhausting but it's still doing something. Katie: Yeah, and it definitely did for me. My prodromal labor was a nighttime thing. The sun would go down. I'd put the kids to bed and it would start with irregular contractions. It felt like period cramps then I wouldn't sleep all night with that. I had that for two nights and then I was finally– Meagan: Typical prodromal. Katie: Then it would go away during the daytime. Meagan: It's so annoying. It's like, seriously? Fine. If you're going to do prodromal, at least do it during the day when I'm awake but don't take away my sleep. Katie: I know. At that point, I was getting super disheartened. I decided to schedule my induction because if this was going to happen every night, I would have zero energy for this VBAC. I did schedule my induction for 41 and 3 I believe if I made it to that point but I decided to go back and get my fourth membrane sweep June 3rd so the day before she was born. That started something. The midwife was like, “Okay, if I do this, I might see you back here later tonight.” Meagan: That's a promising thing to hear. Katie: Yeah, so once she did that sweep, I was actually already 4.5 centimeters dilated. That prodromal labor was doing something. Meagan: Um, 100%. Katie: Yep. That morning I had that sweep. We went to get lunch. We walked around. I was starting to right away have contractions and these were during the day so I knew something was up. By 4:00 PM that day, I was feeling it. I was starting to need counterpressure and had to stop what I was doing. Based on what the doula had said, that was when I should call them. I texted her and I told her, “I'm having these contractions that I'm having to stop and breathe through but they are still 10 minutes apart so I don't know what's going on.” She's like, "Okay. I think you need to stay home a little longer. You're probably not in active labor yet.” I'm like, "No, I think I'm there. Things are really intense.” Despite what she said, I headed to the hospital.It's a good thing I did because by the time I arrived at 10:00 PM, I was already 6.5 centimeters. Meagan: Okay, nice. Katie: I was very surprised because usually what the doula community says is sometimes when you head to the hospital when you are not in active labor, things can slow down because of the change of scenery and yeah, your body just shuts down. But in my case, it actually was the reverse. I went from super irregular contractions to walking up to the hospital doors and they started coming super regularly like 2-3 minutes apart. Yeah. Meagan: I do feel like the opposite can also happen where our body gets to that final destination and it's like, Okay. You can do this now. You have this sense of release. What you were saying, yes I've seen that too where the mom has to reacclimate to the space and labor stalls a little bit then it goes on, but this one it sounds like it was the opposite where it maybe brought you relaxation and safety. Katie: Yeah. I think maybe part of it was that this hospital experience was so different than my last one. At the last one, it was rushing to the hospital while I'm bleeding. I get there and there's this rush of nurses. Everyone's checking me and this time, I waddled up to the hospital. The room was dark. There was one nurse checking me in. I'm just chilling on the bed. I was just relaxed. I think a lot of the things that I did with the doulas to prepare, like they did classes about comfort measures and things like that and I was really trying to use those. I got the twinkle lights set up and got the music so that really helped. By 1:00 AM, I was already feeling the urge to push and I was feeling so much pressure, especially in my butt. I needed counterpressure for every single contraction up to that point then I was like, “No more counterpressure.” I was screaming for my husband to stop doing it because it was starting to hurt. I knew that something was happening. I was on my side trying to get some rest in between and I was starting to give up at that point. I know what they say is when you are starting to give up, you're starting transition. Meagan: You're right there. Katie: For me, I was thinking, I need an epidural right now. Meagan: A lot of people do though. A lot of people are like, “I can't do this anymore. I'm done. That's that. I need that epidural. I need relief now.” Katie: Yep. I hadn't had a check since I was admitted. It had been about 5 hours since I showed up or 4 hours since I showed up to the hospital so I was like, This can't be it. I can't be ready to push because I've only been here 4 hours and it's my first labor. I was in disbelief but I was like, “I need a check right now because if I'm not close to pushing, I'm getting the epidural.” The doula was trying to talk me out of it. She was like, "Are you sure? What are you going to do if you're not there?” I'm like, "I'm going to get the epidural.” I was 9.5 centimeters at that point. Meagan: Oh yeah. Right there. Katie: Yeah, and I was like, "Oh my gosh. This is actually happening.” My body was starting to push on its own and it was such a weird feeling. It was so different than my friend's birth that I photographed. She had an epidural and it was an induction. That's the only other birth that I've seen and this was so different because my body was pushing. I can't control it. Yeah. That was about an hour of pushing which felt like an eternity and the contractions were actually fine at that point. I couldn't feel them. I could just feel loads of pressure and the ring of fire which was intense, super duper intense. Then my water broke about 10 minutes before she was born and yeah, she was born. Meagan: You get to 10, your water is probably going out through breaks and baby comes down. Katie: Yeah, I had a bulging bag at the end which is really interesting to feel. She was born at 2:34 AM. Meagan: Aww, that's awesome. So pretty dang quick. Katie: Yeah. If you don't count the two nights of prodromal labor. Meagan: Prodromal labor, yeah. But your body was doing it slowly and surely. Each sweep did give you that extra nudge. It maybe gave you some prodromal labor along the way, but it seemed like it was helping and doing something. Katie: Yeah, if that helped me avoid a medical induction, I'm super glad that I did those. Meagan: Yeah, that's something when it comes to someone facing an induction or facing that hurdle, a membrane sweep might not be a bad idea. But too, with that said, if we go in and we are barely 1 centimeter or our cervix is really posterior and we are 30% effaced, we need to know mentally that if we go for a sweep, the chances of it working is a lot lower. It's just lower because our body is maybe not ready. It also doesn't mean it's not going to work. So like I said earlier, you had that ideal cervical stat. You were that 2 centimeters and 80% effaced. Things were looking good and softer, starting to open and they were able to get a really good sweep but even then, it took time. Katie: Yeah, definitely. My midwives never pressured induction on me. I was pressuring myself mainly because IVF pregnancies– there are differing opinions but some doctors say that you should be induced at 39 weeks and some say you shouldn't go past your due date because of the placenta not being as good. Meagan: Well, yeah. It's so hard because– so twins were IVF and was this baby IVF too?Katie: Yeah. Meagan: Okay, that is hard because there are a lot of people who do say that you should induce at 38-39 weeks with IVF and we do know out there that with IVF, the chances of having placenta issues and abnormalities like abruption are increased. Accreta, previa, and things like that. But if everything is going okay, all is looking well, it's that battle of do we induce? Do we not induce? What do we do?Obviously, your providers weren't pushing it so they didn't see any real medical need but then we have other providers on the complete opposite end where they are pushing it hard. Katie: Yeah, in some of my IVF groups on Facebook, basically every single person is induced or has a C-section. It's pretty rare for a provider to say you can go to 42 weeks like mine did. Meagan: Interesting. I actually don't know the real stats on IVF placental issues after 38 weeks. Had anybody ever talked to you about what your chance of issues really were after a certain point?Katie: No. The abruption was I think more of a risk factor was that it was twins and my uterus was so stretched but no one really mentioned placental issues or even said, “Let's look at your placenta after 40 weeks.” They do have the standard ultrasound to look at baby and do the BPP test, but they said that there is nothing really you can see from an ultrasound after your due date. Meagan: We know that ultrasounds can be off by size and by all the things. Katie: Yeah, and she was measuring bigger. She was 85th percentile which was actually true. She was born 8 pounds, 4 ounces so she wasn't tiny like my twins were. Meagan: Yeah. I Googled really, really quickly. This isn't even a study. This is just an article on it. I'll try to get some more studies and things in here but I'm going to include this article. It's from the Real Birth Company. It looks like they are teachers of birth classes. It's highlighted. It says, “What do you need to know if you are pregnant through IVF and you're being advised to have an induction because you are told that there is a higher chance of stillbirth?” It says, “The only study that we found that gives us the information also noted at higher risk of stillbirth for IVF pregnancies, but crucially, they said no increase in their rate of stillbirth after 28 weeks of pregnancy. It just says, “This research therefore tells us that induction at terms would not necessarily reduce stillbirth rates for babies who are conceived by IVF.”Katie: Yeah. From my understanding, it's hard to do studies on this because a lot of women who need IVF have other health factors which can increase the risk of obviously stillbirth and other issues in pregnancy. Meagan: Yeah, it's showing that sometimes IVF moms have placenta accreta and placental abruption at a higher risk. It shows that IUGR babies have a higher chance for being smaller. It also says that gestational diabetes and preeclampsia have an increased chance. So like you said, there are other things that they may have. I'm just going to throw this in there in case anyone listening is an IVF mama and wants to know more. It's interesting that you're saying that in that group– are they scheduling C-sections?Katie: Yeah. Most women get scheduled C-sections, not scheduled C-sections, scheduled inductions but they end in a C-section because they aren't ready. Meagan: Okay, so they aren't necessarily scheduling them right off the bat just because they are IVF. Katie: Right. Meagan: But again, like you said, they aren't ready and inductions are happening and people are ending up in a Cesarean. Katie: Yes. Meagan: Interesting. Well, this article was written in 2021. I'm also going to put a couple others in here that says actually 2024 so I need to look more into this but it's something to consider because again, this is a space where we are trying to reduce unnecessary Cesareans. We're seeing that it's happening so it might be something that you want to research if you are out there and you are doing IVF, research that and see if it's something that really is necessary for sure. Katie: This is just my personal story, but my placenta looked perfectly fine at 40+5 with this baby. Meagan: Yeah, so everything was looking good at that point. We did talk about that in the beginning– sticky placenta or really retained placenta. Did you have that with this? Maybe you can talk to us more about the placenta. You gave birth to babe. It was a VBAC that was a lot faster than anticipated and you went unmedicated when you didn't think you could. I kind of love that so much that you were like, “I have a low pain tolerance,” but then you did that. It just goes to show how possible it is, right? But yeah, talk to us about your placenta. Katie: Yeah. That was actually worse than the pain of the entire birth and something I didn't expect because I had asked about this because it can be an issue with IVF pregnancies. I had asked about this in one of my prenatal appointments and the midwife said, “We don't know if you're going to have that or not. IVF is a risk factor for it,” but since I had the opposite of a sticky placenta. I had a placenta that was coming off the wall. With my last pregnancy, she was like, “I'm guessing that you're not going to have that,” but I did. After baby was out, my placenta was not coming out after 10 minutes and around 30 minutes, I think they like to have it out by then. So they gave it 10 minutes for it to come out naturally, but my contractions completely stopped. Nothing was happening at that point. My body wasn't expelling it. They were trying to pull on it. Eventually, it came out but I was still having bleeding when they were pressing on my stomach than they would like to see. They gave me the Pitocin and that didn't work and then they tried two or three other medications. Meagan: Did they give you Cytotec at all? Katie: Yeah, I think so and another medication that goes in the back in the booty. Meagan: Oh, yes. They usually will insert it rectally. Yes. Yes. Cytotec is not okay when we are pregnant and we are trying to go into labor, but because it makes the uterus contract so hard which is the whole issue with Cytotec and VBAC, it can help reduce bleeding and help the placenta and all of these things. Yeah. Katie: Yeah. They gave me the max dose of Pitocin in my IV and none of that worked. They gave me the Pitocin in the leg and that didn't work, the Cytotec. Then they brought out the ultrasound machine and scanned around and saw that there were some pieces left inside. So she had to stick her hand up and get them. That was horrible. Meagan: And you were unmedicated. I'm just going to tell you right now that you have a high pain tolerance. I think you might be incorrect on that. Not saying that really, but holy cow. Unmedicated and a retained placenta retrieval scrape– they are essentially scraping and fishing for your placenta. Katie: Yes and she had to go in two or three times. They gave me some kind of IV medication and all it did was make me feel drunk. Meagan: Probably fentanyl. Katie: It was something with a D maybe. Dimerol.Meagan: Dilaudid. Katie: Maybe Dilaudid. It made me feel loopy and nauseous but did nothing for the pain. I was holding my baby the whole time and I just want to forget that horrible experience. Meagan: That is rough. Sometimes placentas “stay sticky” and it really can take up to an hour even for a placenta to come out. Sometimes we don't know why and like you said, IVF stuff maybe could have helped but the placenta usually is in that 5 to 30-minute period and providers do start to worry if it's more than that because after we have our baby, our cervix was 10 centimters. It dilated and everything was open and thinned and then it starts coming back and closing again which is the normal process. Katie: Oh my gosh. I didn't even think of that. Meagan: Yeah, it's just that normal process where it starts closing so providers start fearing that if the cervix is closed or too small, the placenta can't move through and then we've got the placenta inside and retained placenta is a very serious thing. You want to get your placenta out. It's an amazing organ and functions amazingly. It raises these amazing babies through these 9 months. It supports them and feeds them but we need to get it out because retained placenta can make you very sick. They start fearing that and sometimes when they are tugging, it can make it so the blood vessels get ripped off or they weren't ready so then we have bleeding and retained placenta and all of these things. They start fearing it and things like breastfeeding, Pitocin, Cytotec, and all of these things that they are trying to get to help you contract more is an effort to help get that out. But yeah. That is a lot. That's a lot. You had this beautiful birth and then whoa, quite a lot right there. Katie: Yeah, a bit of a turn and in addition to that, I had a second-degree tear that they also had to stitch me up. I don't remember if that was before or after the whole extraction. Meagan: Your provider fishing could have caused more tearing. Yeah. There is also a possibility that if for some reason it doesn't come out that you will have to be taken to an OR which is a more rare circumstance but I've had one client in all the 10 years of doing this and she was a VBAC client too actually. She had a beautiful birth and then had to go in and get it manually removed. So yeah, breastfeeding as soon as you can, changing positions and also emptying your bladder is something that you can do because if your bladder is full then it can hold things up so sometimes it's detached but not coming out so there are things we can do and then of course, taking medication and going a step further if we really need to. Katie: Yeah. Overall though, I don't regret any of that. It was still such a beautiful birth even though the end and the golden hour took a turn, it still was more than I had imagined. Meagan: Yeah. I was actually going to ask you. Even with that which is a lot, would you still suggest doing it or would you have done it differently if you could go back?Katie: No regrets. The recovery was a million times easier even with the tear and all of that. I was going to the botanical garden 4 days postpartum with my family. Meagan: Oh my gosh. You were out walking around. Katie: Yeah. Meagan: Oh my gosh. That is amazing. That is amazing. Katie: With toddlers, you've got to get back to real life. Meagan: I know. It's so hard to take that break and recover when we have life that is still moving around us. Katie: Definitely. Meagan: Remind me, you said you took Needed's collagen, right? Katie: I did. Yeah. Meagan: That actually probably helped healing as well. Katie: Yeah. I love that stuff because I wanted to get more protein in. I just put it in my shakes along with all of the other things that I did like the chiropractor and the dates. I did all of the things. Meagan: Yes. And your doulas, do you want to do a shoutout? Katie: Yeah, 3-1-2 doulas and I worked with Heather. Meagan: Awesome. Katie: Yeah, and they have awesome classes too. If you are a doula customer, they are free and if you're not, you can still sign up for them and they are super great. Meagan: That is so awesome. We love our doulas and to all of those listeners out there, just a reminder. We have a major doula directory from literally all over the US to outside of the US if you are looking for doulas too. You can go to thevbaclink.com/findadoula. We love our doulas so dang much. Obviously, I love doulas so much I became one. Doulas are so amazing. I love that you said you did chiropractic care and dates and all of the things. Are there any other suggestions or tips that you would give our listeners as they are going through their VBAC journey? Katie: Yeah, just listen to these podcasts a lot and you'll learn so much. Join The VBAC Link group on Facebook. Meagan: Yes. I love that community. Isn't it just amazing? Katie: Yeah, it's great. There's also another VBAC Facebook group that I loved as well. Meagan: Do you remember the name?Katie: I don't remember. Meagan: There are a few on there. We love– Katie: VBAC Support Group. Yeah, that one's great. Meagan: Awesome. Katie: Yeah, just believe in yourself. You can do it. You are a badass. Meagan: You are a badass and you can do it. I agree. We'll end on that note because that is such a true statement. Girl, you are amazing and I'm so grateful for you sharing these beautiful stories today. Katie: Thank you so much for having me.ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Rachel is a professor, an author, and a VBAC mom who is here to share her story from a traumatic C-section birth through a VBAC. This episode really dives deep into how picking the right provider is key to improving your chances for a VBAC. They give practical questions to ask your providers, more than just yes or no, to really get to know their birth philosophy and what qualifications and experiences your provider might have that would make them a better fit for VBAC chances. Rachel and Meagan also give a lot of validation and advice on how to start the process of overcoming birth trauma; it's reality and to not be ashamed of it. You're not alone. Through the many important messages of this episode, they both mention many times to trust your intuition. If something feels off, listen to that. And if a change in provider is necessary…it is never ever too late to change. Invisible Labor: The Untold Story of the Cesarean SectionHow to Naturally Induce LaborHow to Turn Prodromal Labor into Active LaborMembrane Sweeps for VBACHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello everybody! Welcome to the show! I am so honored to have Rachel Somerstein on with us today. She is a friend of ours from New York. She is a writer and an associate professor of journalism at SUNY New Paltz. She is an author of Invisible Labor: The Untold Story of the Cesarean Section.  And her writing has also appeared in the Boston Globe, The Guardian, The Washington Post, and Women's Health. She lives in Hudson Valley, NY with her husband and her two children and is here to share her stories with you today. Rachel had an unplanned Xesarean section with her first child and the experience was anything but routine. I know that there are many of us who have been through this journey and on this podcast, maybe listening today, that also had an unexpected experience and it may have left us with trauma, or doubt, or fear, or all the feelings, right? And so she is going to be talking to us today about her experiences, but then also we're going to talk about some guidance on how to find peace and to offer ourselves grace and to set ourselves up for a much better experience next time. We do have a review of the week, so I want to get into that and I'm going to turn the time over to Rachel.This review is by Deserie Jacobsen. The review title is “Thank You.” She actually emailed this in and it says, “This podcast and parents course is amazing. I am not a VBAC mom, but I have been listening since 2020. I binge listen near the end of every pregnancy to remind me of everything I need to remember in birth and process through my previous births. This time around I felt more prepared than ever before, having plans in place just in case. We were able to have a quick birth of my 5th baby. I love the education, passion, and love this podcast gives. I recommend it to everyone I know, and I have learned so much from it. I am so grateful for this podcast, thank you.”Thank you so much Deserie for your review! Seriously you guys, I just love hearing that people are finding the information that they need, they're finding community, they're finding that they can do this too. Just like them, and all these reviewers and all the people that have shared their stories and all these reviewers you guys can too. This birth, VBAC, is possible too. Better experience is possible. A healing CBAC; it's possible. You guys, all it takes is getting the information, the prep, finding the provider, to have a better experience.Meagan: Alright Ms. Rachel, welcome to the show and thank you again so much for being here with us. I kind of talked about this a little bit before we started recording about how I think your episode is going to be so powerful and deep and raw too. You've got these feelings and these words. I love it. I love reading your book and I can't wait to hear it from your own mouth. Which speaking of book, can we talk about that a little bit? What kind of just inspired you, jumpstarted you into writing a book about this?Rachel: Well, I'm a writer. And I wrote an essay about my birth about two years after I had my baby, my first birth, my C-section. And I realized I had a lot more to say and also I heard from a lot of moms when that came out and that made me start thinking that I think there was a bigger project. Meagan: Absolutely. And an amazing project that you completed.Rachel: Yes.Meagan: And remind everybody before we get into your stories where they can find your book. I actually have it here in my hands. It's Invisible Labor. So where all can they find that? And we'll make sure that we link it. Rachel: Sure, thank you! Yeah, so it's Invisible Labor: The Untold Story of The Cesarean Section. And you can get it on Amazon, you can get it from Barnes and Noble, you can get it from your local bookstore, you can get it as an audiobook? Or you can also get it as an ebook.Meagan: For the audiobook, did you record it?Rachel: I did not. The narrator is Xe Sands and she did a great, great job. It sounds excellent. Meagan: Awesome. We'll be sure to link that. I think it's definitely a book that everyone should check out. There's a lot of power in that book.Rachel: Thank you.Meagan: And it's not even just your story. I mean there's a ton. Like if you go through the note section there's a ton of research in there, and history and studies, and so many really great things. Well okay, let's hear about the story that started the inspiration and behind this amazing book.Rachel: Sure! Thank you. So like so many moms, I had an unplanned C-section that I was completely unprepared for, which is another reason I wanted to write this book because I think a lot of people go into pregnancy just assuming they're going to have a vaginal birth and like me, I didn't even read the parts of the books about C-sections, I skipped them. Because I was not going to have a C-section. Which is whatever, hindsight is everything, right? But I had a totally textbook pregnancy. I switched to a different group of midwives and OB's about halfway through because I just didn't have a connection I felt with the providers in the first one. And frankly, I didn't have a connection with the providers in the second one either, but by that point, I was like well whatever, it's fine. Which I think is actually, if I could go back and do it again I would have changed that. But you kind of are like, I don't want to, could I possibly change again? And I think that for people who are VBACing, yes you can and sometimes you actually really need to, even like late on in your pregnancy, people will switch groups or providers even late in the third trimester, so. Meagan: Even if you're changed already, you can do it multiple times.Rachel: Exactly.Meagan: It's not a bad thing to find the right provider for you. It's not. Rachel: It's not. And It's hard. And you can feel like, Oh my god. Am I really going to send all my records over? It can feel like so much effort and it can really be worth it. I just wanted to say that as someone who switched once and then was like, Okay, I'm done, and wished I'd switched again. So anyways, it was late in week 39 I went into prodromal labor but I didn't know that prodromal labor even existed because nobody told me about it.  And it was my first baby. So I was like is this labor? I think I'm having contractions, these are not Braxton Hicks. And in the end, we talked to the doula I was working with, and in the end they ended up petering out. And at that, I think that that for me marked the beginning of, this is not going to look like the way I had expected it to look. And again, hindsight is everything. What I wish I had known at the time– and I think this is really relevant to some VBAC moms is that sometimes prodromal labor means that your baby is not in the best position for having a vaginal birth. And I can't exactly say oh I would have done this or that differently if I'd known it, but it would have helped me understand what I was going into with the labor and the birth. So anyway, I eventually went into labor in the middle of the night. It was exactly my due date and I knew it was different. I could just feel this is labor. And I was really eager to get it going quickly. And again, I wish someone would have said, “Rachel, rest. It's early. You're going to need your strength. You're going to need your energy however your baby is born.” And instead I quite literally was running up and down the stairs of my house to try to push labor along. Which is, I have compassion for myself, I understand why I was doing that. What I really needed to do was get in the bath, or I don't know, lay over the birth ball. Watch a silly movie, right? The feelings I was having were real pain and I was scared. But you kind of can't run through this, especially a first labor as we all know, those take a long time, right?Meagan: Yeah. And if we were having prodromal labor, our body may be kicking into labor, but still might need some time to help that baby rotate and change positions. Rachel: Exactly, exactly. And this is the kind of education that is so missing from birth classes. And that is one reason why this kind of podcast is so helpful because that's how I learned about these different things. I didn't ever learn about them from a provider being like, “Let's talk about what will happen in your birth, and let's talk about why you had prodromal labor.”So anyway, we went to the doctors office where we met a midwife and my doula for a labor check. And I was hardly dilated, I was at a 2 but I was in extreme pain. And I have to say, I have a very, very high pain tolerance and I now know I was having back labor. Meagan: Baby's position.Rachel: Exactly. And the contractions were like boom boom boom boom. They were not, I didn't have any rest in between them. Which again, I think my baby was like I gotta get in the right position, this isn't working out, I'm freaking out, ah! Plus my mom is running around, ah! Right?Meagan: Yeah. Rachel: So we went to the hospital and I was checked in and the midwife who checked me in was like, “Oh you're actually not even 2 centimeters, you're just 1 centimeter dilated.” And they checked me because I was in so much pain I think. And I don't know that that was necessarily wrong,  but again, no one was sort of explaining, “Here's what we think is going on.” And it's partly because I believe those providers thought I was exaggerating what I was experiencing physically. They didn't know me. Well, they didn't know that I'm usually pretty stoic. They didn't know that I'm not a squeaky wheel. And I wasn't like screaming or crying or pounding. I was like quiet and I was like I'm in a lot of pain.Meagan: An intense quiet.Rachel: Intense quiet. Exactly. But that doesn't look like what we think pain looks like to people. And the fact is that people are very individual and how they express pain especially during labor where you're already kind of like leaving the regular plane of reality.Meagan: Yes. Rachel: So an important takeaway is like, even experienced providers cannot read your mind and make mistakes in assessing what's truly going on with you. And this comes up later in my second birth, but my husband now does a much better job of saying, “You might look at Rachel right now and think she looks like she's doing great, but this is what's really going on with her.” And he does that in a way that's not like he's speaking for me in a way that's annoying, but it's like I actually can't advocate for myself, I can't express this. So anyways, I asked for an epidural. They said that the anesthesiologist was busy. Which may have been true, but may have been they were trying to put me off because I was hardly dilated. And they told me to get in the birth tub. And I remember hanging over the side of the tub and staring at the clock on the wall and being like, I actually don't know if I'm going to survive this hour. I was just in so much pain. Incredible pain from back labor that was incessant. Eventually he showed up. They hooked me up to all the monitors. At that point, one of the nurses was like, “Oh, you are having monster contractions.” Like the contractions that were being measured were so intense they were going each time to the edge of what was measurable. And now that the computer said it it was like oh…Meagan: You're validated now. Rachel: Exactly. Right. And the anesthesiologist, it took him three tries to get the epidural working properly which would echo problems to come. But he did, and it took away the pain. And then I was just in the bed and kind of left there. And the nurses and the midwife did not use a peanut ball, they didn't move me around. And obviously, listen, I'm attached to the monitors. You know you cannot really move that well, the belt slips, and that increases the chances you'll have a C-section. And there are still things that can be done. It's not like you're a loaf of bread, you just lay in a bed. But they didn't do that stuff and I wasn't dilating. The nurse and doula eventually basically were like, “Well, we're going to go out for dinner and we'll be back in a few hours and we're going to give you this thing to sleep and if you haven't dilated by the time we get back you're going to have a C-section.” And at that point I was exhausted. It's evening now, I've been up since the middle of the night. I'm totally like, what is happening with this birth? No preparation; I took birth classes, I read books, no preparation suggested that this series of events could take place. I felt completely abandoned by my providers, including my doula who I was paying out of pocket. And one thing that came up at this time also was I had this colposcopy in college, like scraping of cervical cells. I didn't hide it from anybody, I was open. And the midwife said well maybe that's why you're not dilating is because of this colposcopy.Meagan: Do you think you got scar tissue?Rachel: That's what she said. And I remember at the time being like why are we only talking about this now? Why has nobody brought this up in any of the prenatal visits that I've done? And I felt blamed. This thing about your body is defective. After a few hours when the midwife and the doula came back and I rested and it was quiet, I had dilated to a 9. And I think what that's about is that I had been in too much pain to dilate. I was so frozen up and tense and also extremely scared.At this point people are like, “Oh wow.” And finally my water broke,y water hadn't broken. So you know, things are kind of continuing and I am starting to actually feel even more fear and my room is getting really crowded with people. And the midwife asks me to start pushing. And I was afraid and I was excited. They turned on the baby warmer, and they were like, “Okay, your baby is going to come out.” And I started to push but I couldn't feel what I was doing. I had no idea. And the midwife was like, “Do you have an urge to push?” And I was like, “No.” The epidural that hadn't gone well from the beginning had then come down with a very heavy hammer and I felt total numbness. It was not helpful. I needed someone to have turned it off or something, or turned it down so I could feel an urge to push and feel how to push, where to push, what muscles to use. And at a certain point I could tell something was going not right and it turned out that my baby was having heart rate decelerations. So just to sketch the scene. At this point it's 1 o'clock in the morning, I've been awake for 24 hours. I'm exhausted. My husband is exhausted. Neither of us has any idea that things could have gone like this. The midwife says I think it's time to do a C-section. And I don't disagree with her. I don't even know what to think at that point. I'm also feeling tremendous fear. I was like I'm afraid I'm going to die, I'm afraid my baby's going to die. And the overall sense in the room…and people were like, “Oh no, you're going to be fine”. And the sense in the room was that I was hysterical and I was not in my right mind. Which I wasn't in my right mind; I had been awake for a long time, I'd been trying to have this baby, nobody really told me what was going on and I felt totally unsupported. Actually, my response was completely reasonable given the circumstances and nobody really attended to that and saw that and recognized that as completely valid. Plus, I don't have evidence to stack this up absolutely, but I have since come to find out that there is a medication that some laboring women are given to help them rest and one of the side effects is an impending sense of doom. And I have a friend who had a baby at this same hospital and had the same response after having been given something to rest during her labor. I could go back and look at my records and I may do that but I'm like, well that would explain also why I had the response I did. Meagan: Mhmm.Rachel: Anyway, we go to the OR. I hunch my back for the spinal that the anesthesiologist has to do a couple of times to get it right. I'm still contracting at this point. My body is still like, Come on, let's get this baby out. Let's get this baby out. And I'm so uncomfortable. And you know that advice to not lay down flat on your back when you're pregnant, but that's what you have to do when you're in the OR. The whole thing felt like I was going to choke under my stomach and very exposed like you are in the operating room. Meagan: Yeah, it's cold and it's bright and you're very exposed. And you can't move your body normally, especially if you've had a spinal. Rachel: And also in retrospect, again I'm like I cannot believe that the first time I learned what happened in a C-section was in my C-section. I really should have at least learned about this even though it would have still been scary and I still would have been surprised. So when the OB goes to operate, he starts his incision and I say, “I felt that.” And he says, “You'll feel pressure.” And I say, “I felt that.” And he continues operating and I was not numb. I felt the operation. And according to his notes..parts of this I don't remember…but he wrote it down and my husband has also told me that I was screaming, my legs were kicking. There's no question that I was in tremendous pain. And I was moaning and it was horrible. And it was horrible for the people in the room too by the way.Meagan: I'm sure. Rachel: Right? Like it's really important to say that. My OB didn't listen to me. That is a super common thing that happens in healthcare, especially for women. Especially for pregnant women. He's not a sociopath. He didn't want to be evil, but he didn't listen and the consequences were so steep and so dire. And I think that it was traumatizing to him and I know it was traumatizing to some of the other providers in that room, the nurses to watch this. He kept going and when the baby was born, which I don't remember, apparently they held her up to my face and they put me under general anesthesia and sent my baby and my husband away and stitched me up. Then I woke up in recovery. The doula and the midwife had gotten the baby to latch while I was unconscious and were talking about me without knowing that I was awake about her latch which really, really bothered me because it just underscored how it felt like I was just a body. And even people who were supposed to be there to take care of me and be tender and advocates, I felt they disregarded me. And under other circumstances I really would have wanted to breastfeed my baby like right away. But I wasn't even there to say yes I want to do this or no I don't want to do this. It was a terrible birth and I would not wish it on anybody. Meagan: And I think, kind of talking about what you were just talking about with breastfeeding and stuff, these people in their hearts and in their minds were probably like this is what she would have wanted. We're trying to help. But in whole other frame of mind over here, I'm not present. I haven't said those things. And I know you're trying to help and I know that's where your heart is, but I'm not okay with this. Rachel: Totally.Meagan: And I think sometimes as doulas, as birth workers, as any one of you listening, remember that words matter. Actions matter. These moms' feelings matter and it's sometimes in our minds we're trying to do what's best, but it might not be. Rachel: Totally. Absolutely. Yes and I again, it's so important to point out. Yes they were coming from a good place. They really were coming from a good place. But it wasn't the way that I felt it or experienced it. Meagan: And it left you with trauma and angst and heartache. Rachel: Absolutely. Totally. Yeah. Meagan: Well that definitely sounds like a really rough birth. And it's so crazy because it's like you went from not progressing to baby in a poor position, to getting an epidural. I love that you talked about that. That can be an amazing tool. A lot of people are very against epidurals, and there are pros and cons with epidurals. We've talked about those. Fetal heart decels is one of them. I don't think, maybe in this situation it sounds like a lot of other things happened; baby's position being one of the biggest ones. But that can really be a tool that helps you just relax and be more present and have less trauma. We talk about this in my doula practice of where there's a difference between pain and suffering. And pain, progressive positive pain that's bringing our baby to us that's one thing. But when we're suffering and we're so tense that our body's not even able to try; that epidural could come into great play. But again, we're not that loaf of bread in a bed and it is important to move and rotate. And it doesn't have to be drastic. It doesn't have to be crazy big movements. Just subtle movements to change the dynamics of the pelvis and to encourage our baby to keep coming down. So there were so many things that just went poorly but also went well, and then poorly again and then well and then real poorly there at the end. Rachel: And I think like to your point, I went into my birth I should say, I was planning on having an unmedicated vaginal birth. I was like I'm not going to have an epidural. And I think that if my providers had different skills I would have, I may have been able to have that baby vaginally. And I say that based on what happened in my second birth. So it's not just like wishful thinking, right? And I'm really glad I had that epidural. I really needed that. I was suffering. The pain I was experiencing was not productive pain. And an epidural can help you with suffering, alleviate your suffering. But it can't and doesn't substitute for emotional support. And I think that's what was missing for me, throughout that first birth. Even if I had gone on to have ok fine, a cesarean, or even a vaginal birth, I still think I would have been like that wasn't a good birth because I didn't feel emotionally supported. And an epidural can't do that. Meagan: Yeah. No an epidural cannot do that. And I, for anyone listening who supports birth, or even who are going for a birth you kind of mentioned it. You're in this other land and sometimes it's hard to advocate and open. You might be thinking something and you might so badly want to say it. It's right here, coming out. And you can't say it for whatever reason. It's a weird thing, it doesn't make sense sometimes but it can happen. But really being heard, validated, understood; which are so many things you weren't. Right? And when we're not heard and when we don't feel safe, and we don't feel supported, those things leave us with PTSD. In fact there was, in your book, I'm just going to read it. It says, “2022 study by anesthesiology and obstetrics professor Joanna and colleagues found that what's important about women who feel pain during childbirth is how mothers feel about their pain. And how their providers communicate with them overall…”You were communicating, and no one was communicating to you. “...feeling positively about pain and heard by providers protects a mother from developing PTSD.” And I mean it goes on which is why you need to get the book so you can read more about it. Rachel: Yep. Meagan: But really, feeling heard. Rachel: It's not just crunchy whoo-hoo feels good, feels right, sounds good. It really matters. And I have to say that I'm participating in and helping to work with providers on designing some studies about providing different pain options for moms during C-sections. We literally had a conversation about this yesterday. And one of things we were talking about is it's not just the pain. It's not just pain relief. It's also being listened to. Because there will be people who are like, I might say I'm in pain, but that doesn't mean I need an epidural or want an epidural. But I'm feeling pain and I want to be heard and I want somebody to…even if you can't express this. You can't even express it because you're the one having labor. What you're needing is someone to see you and look you in the eye and be like you're going to be okay. And I think as mothers we totally are experienced with that all the time. When your child is hurt or sick, part of your job obviously is to get them the help they need, but it's also to assure them this nosebleed is going to end. You're not going to have a bloody nose for the rest of your life. Which, when you're going through something really hard you can sometimes forget, right? And you're pointing out from the studies this helps to prevent people in birth, in labor, from developing PTSD. The stakes are really high. They matter so much. Meagan: When you were just talking, I don't know if you saw my eyes kind of well up a little, but I connected a lot with my first birth when I was clinging to a bed, literally clinging. And I was looking at my husband and I'm like, “Do something!” I had a baby in a poor position. I was being jacked full of pitocin. My water had broken, there was a lot of discomfort going on. I had told him I didn't want an epidural and he's like what do you want me to do? And I was like I don't know, I just need something! And I was terrified and desperate. And he was just like… It wasn't fair for me to put him in that position either but at the same time he was like I don't know, I don't know what to do, right? And the nurses were just like we'll just get you an epidural. And I was like no, I don't want an epidural. And then it just was like epidural, just went down from there. And I wish so badly that there was something else. Let's get you out of the bed. Let's get you in the shower. Let's give you some nitrous. There was so much more that I could have had, but wasn't even offered. And I think too, I needed someone to tell me that nosebleed was going to end. Rachel: Yes. Meagan: And it was going to end and it was going to come back every five minutes and it was going to end again and I was going to be okay. And I was going to survive that. And just hearing you talk about that, why my eyes got all welly, is that I don't know if I realized how much that impacted me until just barely. And here I am, my daughter is almost 13.Rachel: Just like how powerful these things that, I don't know, this is part of why we have these conversations. They shed different corners of light on our experiences that it's like oh my gosh, I didn't even know I knew that. And that's so why we, even though I'm not postpartum immediately, it's valuable for me to talk about it too; to hear what you're saying, you know?Meagan: Yeah. Ah, so after a not-so-amazing experience, going into that postpartum, you've talked a little bit about that in your book. Well, not a little bit, you've talked about that a lot. Tell us about that journey and then what led you to deciding on VBAC and ultimately going and having a VBAC. Rachel: So I should say, I was really…Talk about not realizing things right away. It took me a long time to figure out how traumatized I had been by that birth. And I was about two years postpartum and I was having a procedure for something else and I just completely, I had a panic attack. I had never had a panic attack before, I didn't know what it was and couldn't have explained what was happening. And when the anesthesiologist who did this procedure was like have you ever had any issues with anesthesia, which is exactly the question that should be asked, and I had said what had happened he was so taken aback. He was shocked and didn't know what to say and walked out of the room.Not in the way of, I'm abandoning my patient, but just like from his perspective here's this kind of routine thing. This patient is crying and shaking and talking about this very traumatic incident which I had not talked about. I didn't go to therapy. I had talked about it with friends and my family, it wasn't a secret, but I felt a lot of shame. I felt like I must have been this total freak of a person that this had happened to me. And after that I remember saying to my husband, I just don't know if I'm ever going to be able to get over this trauma enough to have another baby. And I didn't even know if I wanted another baby, like separate from the trauma. In therapy I started to see that I felt very stuck in my life and that included how and whether to grow my family. And that was actually because of the traumatic birth. It just like made this big block. I think one thing that's important to think about for those who have had a traumatic birth is that sometimes that can show up in your life in ways that you don't expect. Meagan: Yes. Rachel: And so to be compassionate with yourself about that and also to be open to that. We're in the era of warnings and trigger warnings and those are important, but sometimes for a traumatized person the things that are triggering or activating are not what you would think. Like for me, I couldn't watch a scene of a hospital birth even if it was happy without getting very uncomfortable and having to walk away and there wouldn't be a content warning on that. So it's just to say be patient with yourself. Accept that…don't, I guess if you've had a traumatizing birth you don't have to struggle against these things. As horrible as they might feel, as uncomfortable as they might feel it's normal and it's ok and it shows up differently for everybody. Rachel: Yeah so I had this big question and then I was like ok, it took awhile for me to be like I do want to have another baby. But I wasn't ready emotionally. And so I waited. And then about, let's see, October of 2019, I was like I think that I'm ready to try to have another baby. And we had met this midwife who lived in our community, who my daughter actually made friends with her niece at our public pool which is so beautiful. I ran into her one night while she was walking her dog. She was like your husband shared a little bit with me, if you ever want to talk. And this, I feel like, I could not be more grateful that this person came into my life. She just is, her skills are phenomenal. Just as a clinician in terms of trauma-informed care, and I've felt safe enough going to her for prenatal care to decide that I was ready to get pregnant. My joke is that I should tour high schools and be like it only takes once to have unprotected sex to become a parent. And I was really lucky that I got pregnant right away and at that point I was 37. So I should say I had my first baby at 33 and I got pregnant again at 37. And that's not always the case for people. Obviously it can take a long time and especially after a C-section, secondary infertility is real. Meagan: It is. Rachel: Yeah. Not talked about enough. Really not talked about enough. Meagan: There's a lot of things, right, about C-sections that is not discussed about. For personal, for the mom, for the individual, the infertility, adhesions, all those things. Just the emotional and the physical. Then even the baby. There's risks for the baby, the allergies, the microbiome getting messed up. All the risks, it's just not discussed. Rachel: No, it's really not. And you kind of only find out later if you've had a C-section and you've had a problem down the road that you're like, maybe that's because of my C-section. It's ridiculous.So we got pregnant and I was not sure if I wanted to have a VBAC, but I started thinking about it from the beginning. And I also was like, if I don't have a VBAC how am I ever going to get myself into an OR, I just don't know. And I really think that VBAC is the under-discussed pain point for moms. And I'm preaching to the choir here but we're talking about half a million moms every year have to make this decision, if it's even available to them. Meagan: I was going to say, if it's even offered. Rachel: If it's even offered. Which is totally not a given. But theoretically, they do have this decision and I really have not…I should say, in the course of writing this book, but also just being a mom who had a bad C-section and then had a VBAC, I hear from people a lot about their journeys just like on the playground. Every person I've talked to, they agonize over it. No matter what they choose, no matter what. Why is that not talked about more? I mean that part of what this podcast is doing that's so important, but I still can't believe how under the radar it is, yet it's such a big deal when you're going through it. So anyway, I told myself I did not have to decide right away about a VBAC or a C-section. My midwife was like you can totally have a VBAC, you can totally have a C-section. Even if you have a C-section you can keep seeing me. I was worried like oh would I get bumped out of midwifery care. One of the things I'm really fortunate about and that I think is really good about that practice is that she has a very close relationship with one of the OB's there. Like they kind of share patients, I should say that. And that's because she's worked with him for a long time and he really respects her clinical skills and vice versa. The other thing about her that's unique and that I didn't know how important it is she's a Certified Nurse Midwife, so she attends births in the hospital. But she previously had been a homebirth practice and at a birth center as a CNM. So her skills are, like I said are phenomenal. A C-section is truly like we have to do this. I've run out of my bag of skills or like the baby or mom's health suggests that like we need to do this now. She worked with me to work with the scheduler so that I saw her for every visit which helped me to learn how to trust her and she didn't pressure me. Either way she was completely open. She also worked with me to make sure that I could see her for virtually every visit so that way she earned my trust. And I got to show her who I am. She got to understand me which was really important to the birth. Meagan: Yes, which I want to point out. There are a lot of providers these days that are working in groups. And I understand why they're working in groups. They're overworked, definitely not rested. There's reasons why, both midwives and OBGYNs are working in these big practices. But the thing is it's really nice to have that established relationship but for some reason specially for VBAC it's so important to have that one-on-one relationship. So if you can, during your search for finding providers, if you can find a provider that is going to be like Rachel's midwife where she's just like I want to get to know you, I want to establish this relationship. Yes, we have this OB over here but I want to be your person. I definitely think it's impactful.Rachel: I totally agree with you and I didn't even know that was possible. And she works for a big group and even so she told the schedulers, hey make sure you schedule her with me. She didn't just do that with me by the way, it wasn't just a special favor for this traumatized patient. And frankly it's better for the providers too because they're not coming in cold. Like ok who's this person, and she's saying this. And what's her prenatal care like? What's her pregnancy like? Of course they're looking at the notes, but it's not the same. Meagan: It isn't. And I love that she said that. But I also want to point out that you can request that. If you're in a group and you can connect whole-heartedly with someone and you feel it's definitely who you need, it's ok to ask hey. I know that I am supposed to meet Sarah Jane and Sally, but can I stay with whoever. And maybe you might not get every visit, but if you can get more visits than only that one? It's worth asking. Rachel: Totally. And also then you know their style. So like she was not an alarmist. Let's say I was over 35; I had to see a MFM just because of my age. That went fine, but if something had come up, like let's say I had a short cervix or there was something I found in an appointment with an MFM specialist I would know her well enough to take that to her to be like, put it to me straight. How worried should I be about this? As opposed to maybe this one's an alarmist, this one is more like ahh let me put this in…And the only way you're going to learn about that is from meeting with them again and again. And for VBAC that's so so important. Meagan: It is. It kind of reminds me of dating. It's weird. I had said this with my provider when I didn't switch. I was like, I feel like I'm breaking up with him. Like he's my second boyfriend, it's just weird. It's not really boyfriend but you know what I mean. But it is, we're dating them. And anyone, in my opinion, can come off really great for that first date because they're wanting to make that impression. They're wanting you to like them. But the more you get to know them, the more they may show their true colors. And you also may realize, I don't think I'm the right person for you. My desires aren't something that aligns with you and so I don't want to put you in this situation. And so if we date our providers, “date our providers,” a little bit more than just one time it really will help us know. And like you said, if something were to come up you could have that trusted person in your corner, which is so important for VBAC, that you can go to. Rachel: Totally. Yeah. So yeah, so pregnancy went well. And then right as I entered my third trimester it started to be COVID. Meagan: Mhmmm. The joys. Rachel: Nobody saw that coming. And then you know, things for the entire society obviously went completely off the rails. Obviously something like COVID is, we hope, not even once in a generation. Once in a hundred years experience. But given all the stuff that was up in the air, boy was I glad that there was one provider who I trusted. Who I could be like ok what do I do, what do I do. And I have to tell you that she and my daughter's pediatrician…I'm a professor. So I should say I'm in the classroom with young people who, you get sick a lot anyways. They're living in dorms, like they're not taking the best care of themselves. So COVID was circulating, and we live right outside New York City, COVID was circulating early here and I have a lot of colleagues that ended up getting it. And both my midwife and my child's pediatrician told me early you need to stop going in person, it's too dangerous for you. And I trust my daughter's pediatrician a lot, you know we have a nice relationship and I really trusted my midwife. Right? So I followed that advice and was really fortunate because boy. You know what you don't want while pregnant? COVID. And you know what you really didn't want? COVID in 2020 when you were pregnant and nobody knew anything, you know?Meagan: Right? Rachel: So, the blessing in disguise was that I was able to work from home. And it was super stressful because I had my daughter and my husband was here and you know, my husband is a photographer…I mean the funny thing is that I ended up, not my head but my body, being in these different photos he ended up taking and my belly was getting bigger and bigger and we kind of had to hide it. I'd be holding a book, or cleaning something. It was an absurd, crazy, isolating, scary, and also funny time. You know the blessing in disguise was that I wasn't on my feet as much and I think that that was really good for me as a pregnant person. There is also data that preterm birth went down during the lockdowns because people got to stay home and they don't necessarily get to do that leading up to birth, which tells us a lot about what we need and the rest we need and aren't getting. So anyway, at first everything went virtual and then when I started going in again for my appointments I had met the OB who works closely with my midwife. And we talked about what would happen if I went over 40 weeks. And he was like well, we're not going to automatically schedule a C-section, we would talk about potentially waiting or induction. And I really appreciated having that conversation with him because I understood where he was coming from and it wasn't again like we're going to schedule a C-section right now. So we know if you get to 40+3 and you haven't had the baby, bing bang boom. And that was very important information about his risk tolerance and his stance. Just like with my first birth I went into prodromal labor a few days before my due date. I had had a membrane sweep with my midwife. My in-laws came to stay with my daughter and we went to the hospital on a Saturday night. I didn't know this but my father-in-law told my husband I think she's getting ahead of her skis. And he was right in the end. So we get to the hospital and my contractions stop. And I'm like oh no. And my midwife was like, they put me on the monitor to get a strip which is like you know, what happens. Meagan: Normal.Rachel: And my midwife was like listen, your baby, he's not looking that good on the monitor. I want you to rest for a little bit and let's see. So I'll check back in with you in like half an hour. And I was so upset. I remember being like I can totally see where this is going to go and I had learned about VBAC in terms of like what could increase the chance of rupture or not and I was like I'm going to end up with another C-section and I'm going to be caught in the net. I didn't even have a shot, is what I felt. And then she came back half an hour later and she was like, “He looks great. I think he was just sleeping, and if you want to go home you can go home.”  And it was like 1 o'clock in the morning. And I was like, “I think we should go home.” I just felt like he's not ready. He's not ready to be born.  And remember, I trusted her so much. She would not tell me this if she thought that there was something…Meagan: If there was something wrong. Rachel: Exactly. She wasn't trying to be my friend. She was my provider. And so it felt really weird to leave and come home and not have a baby. And I thought was this the wrong thing to do, because I live like half an hour from the hospital, and was like no this is it.And then everything was quiet for a few days. And then just like my first labor, my daughter, I went into labor in the middle of the night and I had intense back labor, and I knew like this is the real deal, here we are. And this time I tried to rest. I did like cat/cow and just like anything, child's pose, just anything to feel more comfortable. And I called my midwife at 7 in the morning and she was like, “Okay, I want you to come in and be prepared to go into the hospital from this appointment.” So we did that and at that appointment, I had a headache, I had higher blood pressure, I was dilated to a 6, and she said to me, “Listen. Just so you know, they're not going to let you go home. You're going to the hospital, no matter what if your contractions stop or not whatever. This is what's happening because of how dilated you are, the fact that you have this headache, this BP readings, whatever.” And I was like that's completely reasonable, I felt that way too. You know what I mean? But I really appreciated she communicated that with me so clearly and explained why. So I planned initially to try to have an unmedicated, vaginal birth. My midwife and I had discussed these saline boluses you can have in your, by your, what's it called. Like the triangular bone in your back? I'm totally blanking. Meagan: Your sacrum?Rachel: The sacrum. Yeah, that that can alleviate some pain. And very quickly the pain was, I found it to be unbearable. And I asked for an epidural. And the anaesthesiologist came right away and did a very good job. And the nurses and the midwife who were at the hospital were using a peanut ball and helping me move and really supportive emotionally. And I was still really scared, right? Because I had had this terrible birth before, I thought something would happen to me. And nobody treated me like I was exaggerating or you know like, unreasonable. And that mattered a lot. And I think what's important is you shouldn't have to have gone through a bad birth for people then to take you at face value. With your first birth, it should be the standard for everybody. Meagan: Such a powerful saying right there. Rachel: And they were wonderful, truly, clinically and beside.Meagan: Good.Rachel: And then my midwife surprised me by showing up. She was not on call, she came in at like 9 o'clock, no she came in at like 5 o'clock, like once she'd seen her patients and I was just like oh my god,  so moved to see her. And you know, I was pretty far along at that point and she kind of helped me get into different positions and then it was like okay, it was time to push. And they had managed that epidural so I could feel when it was time to push, and I could feel how she and the nurse were telling me to like push here, right? Like use this, make this go. The pain was really intense but it wasn't suffering, like okay, I'm getting instruction. And as I was pushing I could feel that it wasn't going to work. I was like he's not, his head…I could just feel it. Apparently he was kind of coming and kind of going back up, like his head forward and back. And my midwife was like do I have permission from you to try and move his head? I think his head is not in the best position. And I said yes, and she tried to do it and she couldn't. Her fingers weren't strong enough and then she went to the OB and she told me this later.She said to him can you come and move his head? He'd been trained by midwives in the military, by the way, which is one reason his clinical skills are so amazing.Meagan: That's awesome. Okay.Rachel: Awesome. And at first he apparently was like, oh she's a VBAC, like I can't believe you're asking me to do this. And my midwife, again they trust each other right, and she was like the baby's doing great and the mom's doing great. I really think this is going to work. And he was like okay. So he came in, asked my permission, I said yes and he moved my son's head. My water had not broken again, right? So it's like the same thing as the first one. And once he got in position and I started pushing my water broke in an explosion all over my midwife. That's why they wear goggles, now I know. And she went and changed her clothes. I pushed for 45 minutes and then he came out.Meagan: Oh my gosh. Rachel: It was amazing and I felt so proud and I was completely depleted. I was so high and also so low. And I think what's amazing to me is that it was almost the same labor as my daughter, which just tells me that's how my body tends to do.Meagan: Your pelvis. And some babies need to enter posterior or even in a weird position to actually get down. So that can happen. Rachel: Thank you. And also my water didn't break until the very end so there was buoyancy to be moved, right? And again who knows what would have happened if I had been with this provider the first time. Like maybe these decels really meant that my daughter had to come out like then. That is possible. And that first team did not have the skills of the second team. None of this was even brought up, wasn't even a possibility. And I should say that first birth, I didn't even mention this. The OB that gave me that C-section, later told me that my daughter's head was kind of cocked when he took her out. Which suggests that it was just like my son. And how I'm grateful for my epidural. I'm grateful for, you know, all the things that technological kept me safe, but it was these skills of facilitating vaginal birth that made the difference for me to have that VBAC. Meagan: Absolutely. And the hardest thing for me is seeing that these skills are being lost. Rachel: Yes.Meagan: Or maybe it's not that they're being lost, they're being ignored. And I don't know which one it is. I really don't know because I see people using them. So I feel like it's got to be there. But then I go to other births and I'm like, wait what? You're not going to do anything to help her right here? Or you know, it probably could have been a vaginal birth if we had a provider come in and be like we have  a little asynclitic head, why don't we change into this position and let me see if I can just ever so slightly help this baby's head turn. It just isn't even offered. Rachel: Yes. Meagan: And that's something that I think needs to be added to questions for your provider. In the event that my baby is really low and coming vaginally, but is in a wonky position, what do you do to help my babys' position change to help me have a vaginal birth. And then even further what steps do you take past then if it doesn't work and my baby's so slow. Do we do assisted delivery? What do we do, let's have this conversation. So if it does come up, you're aware. Rachel: I love that. Meagan: I was going to say if your provider says, I don't know/I don't really help, then maybe that's not your right provider. Rachel: And I think what's so smart about that framing is that it's not putting the provider on the defensive of like, what's your training, right? Then it's like, what is your problem? But you're actually asking about their skills and you're asking about their approach, without coming from a place of seeming doubt. Just like, I'm just curious. Meagan: Yeah. Like what could I expect if this were to happen, especially if in the past. Say your C-section was failure to descend, mostly based off on position, we know that this is a big thing. But if your past cesarean was failure to descend, ask those questions to your provider. What steps can you take? What steps can we do together, you and I, to help this baby come out vaginally? Rachel: Totally. And I think also, that way, let's say the VBAC doesn't work out, you won't then be looking back over your shoulder and being like I should of/could of/why didn't I/if only. And you know, what do you want out of your birth experience? Well a lot, but part of it is a sense of peace. Right? That I did the best that I could. That my team did the best that they could.Meagan: Yes. Yeah and really interviewing your provider. Again, dating your provider and asking them the questions, learning more about them and what they do and their view. Taking out the yes and no questions and really trying to get to know this provider and letting them get to know you. I think it's just so impactful. I also, kind of like what you were saying with your first birth, also learning the other types of birth that could happen, you know learning about assisted birth. This is a new thing. Learning if assisted birth trumps a cesarean for you. Would you rather go for an assisted birth, even if it may end in cesarean, would you rather attempt that? Or would you just rather skip that and go right to the cesarean. Really educating yourself and trying not to push off the scary even though it can be scary. Rachel: Yes, yes. I love that you're saying this and I was just thinking about this and talking about this with a friend; there's stuff we hope doesn't happen. But not talking about it or thinking about it isn't going to protect us from it happening, it's just going to mean you're not prepared. Meagan: Yeah.Rachel: If it does happen. And yeah. Meagan: It's a disservice to ourselves. And it's weird. And it's hard to hear those stories. It's hard to hear the CBAC stories, it's hard to hear the uterine rupture stories that we do share on this podcast. Kind of what you're talking about the trigger warnings earlier, yeah it might be a trigger. It really might. But if we know all the signs of uterine rupture leading up to, we can be aware. And it's not something to hyperfocus on. We don't want it to be like oh my gosh I have this weird pain, right now, I don't know. It's not to make you scared, it really isn't. It's to just help you feel educated. Kind of what you were saying too. I don't know what a C-section looked like until I was in my own C-section. Rachel: Yeah. I've been talking about this recently with an anesthesiologist, some anti-anxiety medicine which you might get during a C-section, can cause memory loss. That's a side effect. So the time to decide…Let's say you're not planning on having a C-section. And then you're having a C-section and you're really anxious, really reasonable. The time to decide whether to take that anti-anxiety medicine which might cause memory loss; you should have an opportunity to reflect on that and talk about that  and think about that not only in the moment when you're scared and should I take it right now or not. Meagan: Yeah.Rachel: It's just like that's not a good way to make a decision, you know?Meagan: Yeah. And also learning about alternatives. Okay, these are the side effects of this medication, and I don't think I'm willing to accept that. So let's talk about other medications and those side effects so we can see if we can switch it up.  They have a whole bunch of things in their toolbox when it comes to medication. Rachel: Exactly. Meagan: For nausea. You know I had a medication and it affected my chest. It went all the way into my chest and I had to consciously focus on my chest moving. It was the weirdest feeling. Rachel: Terrifying, yeah. Meagan: I wish I would have known the alternatives to that. Right? So having these educated discussions, learning as much as you can. It's hard and it's scary and it's intimidating to not learn what you don't want. It's understandable, too.Rachel: Completely, completely. But that's informed consent, right? The risks, the benefits, the alternatives. And to go back to the anti-anxiety thing. You might be like okay, what could you do for me non-pharmacologically? Let's say I have a C-section and I'm feeling really anxious. Can I have a doula with me there who's giving me a massage? Can I have a doula there who's maybe put some lavender essence on a washcloth to hold to my nose. Can the anesthesiologist hold my hand and tell me it's going to be okay? And then you start actually opening up real options. Like wow I can have a doula with me?Meagan: Yes. That is something that I am very passionate about. We need to get doulas in the OR way more than we are. And I understand that it's like oh we don't have PPE, or oh it's an extra body, and oh it's a very big surgery, like I understand that. But I have been in the OR a good handful of times. And I understand my position in that room. I understand and respect my position in that room. And I always let an anesthesiologist know, if at any point something happens where I need to leave this room you just tell me. I will leave. No questions asked. But please let me be here with my client. Please let me stroke her hair. Please let me talk to her when dad goes over to baby so she's not alone. When you were put under general anesthesia to be there by your side, whether or not you were waking up in the OR. Because sometimes you could wake up sooner, or waking up in post-operative. Let's get these people here. Let's play music. Let's talk to them. Let's communicate the birth.I mean with my first C-section, they were complaining about the storm outside, they weren't even talking to me, right? And it would have impacted my birth in such a more positive light if I would have been talked to. And I wouldn't have felt like, what's going on. You know and all those things, you talked about it in your book. This drape that is separating us from our birth, it's just wild. So one of the questions we ask when you sign up to be on the podcast is topics of discussion that you would like to share, and one of those things is you said, why it's important to balance preparation for VBAC with an understanding of the systemic forces that promote C-sections. We're kind of talking about that, but do you have anything else to say on that? Rachel: I think that there is so much self-blame for having a C-section, when you wanted to have a vaginal birth. And go back to pain and suffering, that causes suffering. And it's heartbreaking to see that and to feel that. And when I think about it, I think what's important to keep in mind is like there are the particulars of your experience, right? Like your providers had the skills or didn't. They listened or they didn't. Your baby had decels or didn't. Like all that is real. And you're not the first or only person any of that is happening to. So why are we hooked up to electronic fetal monitoring, EFM, as soon as we walk into the hospital? Well that is because of how technology reigns supreme right now in every aspect of our society, but medicine too. And also that like it's an efficient system and medical birth, medicalized birth is all about efficiency and making as much money as possible frankly. Meagan: And there's even deeper history, we talk about that in our VBAC course, about why that was happening around cerebral palsy and what it actually did for cerebral palsy rates. All of these things. It's pretty fascinating when you get into it and understand one, why they do it and does it work? Does it make sense? They do it and just became practice and norm, but it did it actually impact the things that, okay how do I say this. Does it impact the things that they were originally creating it to impact? Rachel: Right. Totally. And it's actually the opposite; it was supposed to bring down the number of C-section rates, or the number of C-sections, when the number was like 4.5% in the early seventies and it's just gone in the opposite direction.There's so much evidence that you use it and it makes you more likely to have a C-section. And so yeah, okay, not your fault. That's the system. And I don't mean it in this way like, that's the system, give up, lay down, don't try to make your own feet, but also just to accept that that's what you're operating in and that's what your providers are operating in too. Right? Use it as a way to let go of the guilt and the shame and the, I messed up. My body messed up. Meagan: Yeah. Because there's so many of us that feel that. Rachel: Yes. Meagan: And it goes into the next topic they were saying that I think really can help us walk away with less of, I messed up. My body messed up. My baby failed me. You know whatever it may be. And doing effective research about the hospitals and their employment patterns and the chances of you even having a VBAC. That does kind of go into the balls in our court where we have to get the education and understand. But even when we do that, even when we don't have the best experience, in the end we're still going to look back at it as we did, WE did, the best we could. Right? And it takes less of that blame on us in a way because we know we did everything we could. Rachel: Yes.Meagan: And sometimes it just still happens. Even if you have the doula. Take the VBAC course. Read all the VBAC books, listen to all the podcasts, understand all the risks. Sometimes it still happens. Rachel: Totally. And I mean I think about in my case, like let's say my midwife hadn't come in for me and my OB hadn't been the one who had been attending that night, maybe I would have had a C-section. Because maybe the people there wouldn't have known how to effectively move my son's head. Even though I like did my best and that's okay. It has to be okay because you can't kind of change it. And again, not to be defeat-ist. But to find peace, just to find peace. Meagan: Yeah. I wish that for our VBAC community is finding peace and giving ourselves grace along our journeys. Because we've had 100's of podcast stories and there are so many of us who are still searching for peace. And still not offering ourselves grace, and putting that blame on us, or whatever, right? Everyone's so different and again, we talked about this earlier, it's just different. But I would love to see our community offering themselves more grace and finding more peace with their experiences along the way. And I don't exactly know what that healing looks like and how that peace is found. Do you have any suggestions on ways you have found peace with a very very very traumatic experience that not only led to trauma in that experience, but even in future procedures, in future experiences you know. Do you have any tips on just, guidance on finding peace? Rachel: I mean, I struggle with this still. And it sounds counterintuitive, but I think like not pushing away your feelings. And in the sense of not wallowing, but also not like struggling against them, trying to quiet them, make them be like ugh I hate this. Ugh I hate that I feel this way. Ugh if only I could get over it. So I'll say like, when I go to the doctor now, I get really scared especially if it's a new person and my blood pressure goes up and sometimes my heart rate goes up and it just sort of happens. And I hate it. And there are times when I'm like ugh I hate this part of me. I just hate it.But then when I'm kind of more accepting and it's like, this is how my body responds. It's understandable that this is how my body responds. And I take a Xanax actually. I say that to really take away the stigma I think that still exists around medical trauma and taking medication to manage your symptoms. I take a low dose Xanax before I go to see a provider and it helps me with my suffering. And also just like accepting. Because also there's this saying, if you struggle against the feelings of suffering, then you kind of suffer twice over. Right?Meagan: You do. Rachel: So I would say that, and then specifically for people who feel they had a traumatic experience, I've found EMDR treatment to be very effective, to deal with stuff in the body. That was pioneered more to deal with people who've been in like combat trauma, but it's very effective for traumatic birth. Tapping is another thing that can be very effective. And you can find that online, like there are different…Meagan: I was gonna say, you can go to YouTube and google trauma tapping or anything like that, and you can actually find some pretty great videos for free on how to do that. And it's pretty wild actually how well it works. Rachel: It really is. Meagan: Sometimes it's like wait, how is this working? It really does work. Rachel: Totally. And also I would say like in terms of again, peace, I think it's really important to speak openly about what has happened to you. And to the extent possible, we're conditioned to be like I'm just going to tie this up with a bow and it's okay. Someone says to you, you've expressed something hard, and they're like oh I'm so sorry and you're like it's okay, I'm going to be okay. Like you don't have to worry so much about reassuring your listener. You can be like yeah I had this C-section, and I'm still kind of upset about it. And yeah, that's how I feel. You don't have to self-qualify that. You know, but my baby is healthy. But I'm okay. But I love my baby. We do that; there's a lot of pressure to do that. And it's okay not to do that. It's okay to be like these are my feelings. And two things can be true at the same time. You can love your baby, and you can also be like I'm not that thrilled with the birth. Meagan: Awe yes. Julie and I have talked about that for years. They don't have to be separate. They can go together. You can love your baby and feel connected to your baby and really not like your birth experience. And you can also, we have found that people prep and then they have a vaginal birth and they're like I actually didn't really like that either. So you know, they don't have to just always be separate. You can be really happy and really be upset at the same time. It's okay to have those feelings, right? I have had things in my life where I've done something and I'm like dang. I really like how it turned out, but I hated the journey to getting there. And that's okay. So I love that you pointed that out. Rachel: Yes. or if you think about how you feel on your children's birthdays. So like I have very different feelings on my daughter's birthdays then my son's birthday. I had a good birth with my son. And it was good not because it was a VBAC, but because I was respected and I felt safe. That's what made that a good birth. Right? Just to be totally clear. I'm really glad I had a VBAC, I'm happy I got what

Erica Nemser is CEO at Ardent, a Series A stage startup that's aiming to help drive industrial decarbonization by developing and selling membranes to perform point source carbon capture. Point source capture differs from direct air capture in that it's focused on concentrated greenhouse gas emissions coming right out of the flue of an industrial system, as opposed to direct air capture (DAC), which attempts to capture emissions from ambient air. Ardent, formerly Compact Membrane Systems, has been operating for 30 years, but its pivot to carbon capture and tech startup status is recent. In this episode, we discuss how Ardent's technology stands out in the point source capture field, the industry's varied approaches to decarbonization, and how Erica's leadership has guided the company's transformation.In this episode, we cover: [2:11] Rebranding from Compact Membrane Systems to Ardent[3:53] Ardent's membrane-based carbon capture solution and how it differs from other technologies [6:29] Erica's background and how it has informed her leadership at Ardent[7:37] Ardent's go-to-market strategy of partnering for scale[12:15] The company's hypothesis around facilitated transport membranes [13:05] An overview of Ardent's approach to industrial carbon capture [18:01]: Ardent's low-energy membrane systems for carbon capture[19:50]: Overview of Ardent's membrane system setup[23:03]: Addressing concerns about prolonging fossil fuel use with carbon capture[25:11]: Erica's perspective on diverse solutions for industrial heat[32:06]: “Carbon Capture as a Service” explained[37:20]: Agricultural sector's interest in carbon capture[45:51]: Ardent's global presence and talent searchEpisode recorded on Aug 1, 2024 (Published on Oct 17, 2024) Get connected with MCJ: Cody Simms X / LinkedInMCJ Podcast / Collective / YouTube*If you liked this episode, please consider giving us a review! You can also reach us via email at info@mcj.vc, where we encourage you to share your feedback on episodes and suggestions for future topics or guests.

News includes the latest release of ElixirLS v0.24.0 and the unveiling of Expert, the upcoming Elixir Language Server. We dive into the details of NervesHub v2.0's improvements for IoT device management and introduce the exciting Elixir Stream Week with José Valim among other top experts. We also look at the exciting updates in Elixir's core Machine Learning libraries and more! Show Notes online - http://podcast.thinkingelixir.com/224 (http://podcast.thinkingelixir.com/224) Elixir Community News https://x.com/lukaszsamson/status/1843038898701864991 (https://x.com/lukaszsamson/status/1843038898701864991?utm_source=thinkingelixir&utm_medium=shownotes) – ElixirLS v0.24.0 was released, marking a major update to the Elixir Language Server. https://elixirforum.com/t/elixirls-the-elixir-language-server/5857/226?u=lukaszsamson (https://elixirforum.com/t/elixirls-the-elixir-language-server/5857/226?u=lukaszsamson?utm_source=thinkingelixir&utm_medium=shownotes) – Discussion on ElixirForum about the latest ElixirLS release. https://github.com/elixir-lsp/elixir-ls/blob/v0.24.0/CHANGELOG.md (https://github.com/elixir-lsp/elixir-ls/blob/v0.24.0/CHANGELOG.md?utm_source=thinkingelixir&utm_medium=shownotes) – Changelog for ElixirLS v0.24.0 detailing improvements and new features. https://github.com/elixir-lang/expert (https://github.com/elixir-lang/expert?utm_source=thinkingelixir&utm_medium=shownotes) – GitHub repository for the new Elixir Language Server named Expert, currently private. https://x.com/lukaszsamson/status/1843039621657272690 (https://x.com/lukaszsamson/status/1843039621657272690?utm_source=thinkingelixir&utm_medium=shownotes) – Łukasz Samson hinted on Twitter about the Expert server's progress towards feature parity with ElixirLS. https://elixir-webrtc.org/elixir-stream-week (https://elixir-webrtc.org/elixir-stream-week?utm_source=thinkingelixir&utm_medium=shownotes) – The Membrane project is organizing 'Elixir Stream Week', an online event from October 21-25, 2024 with top Elixir experts. https://x.com/josevalim/status/1841793652932157908 (https://x.com/josevalim/status/1841793652932157908?utm_source=thinkingelixir&utm_medium=shownotes) – José Valim announced his speaking engagement during Elixir Stream Week, discussing 'Projects that never were: Elixir, LISPs, and MLIR'. https://x.com/TheErlef/status/1843362970442539041 (https://x.com/TheErlef/status/1843362970442539041?utm_source=thinkingelixir&utm_medium=shownotes) – The full schedule for Elixir Stream Week, featuring prominent figures like José Valim, Mateusz Front, and Chris McCord. https://x.com/josevalim/status/1843376791169478955 (https://x.com/josevalim/status/1843376791169478955?utm_source=thinkingelixir&utm_medium=shownotes) – Announcement of new versions of Nx, Axon, and Bumblebee with enhanced features for machine learning in Elixir. https://github.com/elixir-nx/nx (https://github.com/elixir-nx/nx?utm_source=thinkingelixir&utm_medium=shownotes) – GitHub repository for Nx, now at version 0.9.0. https://hex.pm/packages/bumblebee (https://hex.pm/packages/bumblebee?utm_source=thinkingelixir&utm_medium=shownotes) – Hex package for Bumblebee, now at version 0.6.0. https://hex.pm/packages/axon (https://hex.pm/packages/axon?utm_source=thinkingelixir&utm_medium=shownotes) – Hex package for Axon, now at version 0.7.0. https://elixirforum.com/t/nerveshub-v2-0-0-officially-released/66305 (https://elixirforum.com/t/nerveshub-v2-0-0-officially-released/66305?utm_source=thinkingelixir&utm_medium=shownotes) – Discussion on the release of NervesHub v2.0, introducing improvements in IoT device management. https://github.com/nerves-hub/nerveshubweb/releases/tag/v2.0.0 (https://github.com/nerves-hub/nerves_hub_web/releases/tag/v2.0.0?utm_source=thinkingelixir&utm_medium=shownotes) – GitHub release notes for NervesHub v2.0.0, detailing new features and enhancements. https://www.nerves-hub.org/ (https://www.nerves-hub.org/?utm_source=thinkingelixir&utm_medium=shownotes) – Overview of NervesHub, a tool for IoT device management, and its significance. https://x.com/germsvel/status/1843593999946317975 (https://x.com/germsvel/status/1843593999946317975?utm_source=thinkingelixir&utm_medium=shownotes) – German Velasco shares an ElixirStream video tip about HEEx component naming and styling. https://www.elixirstreams.com/tips/anchor-component (https://www.elixirstreams.com/tips/anchor-component?utm_source=thinkingelixir&utm_medium=shownotes) – Detailed tip by German Velasco on creating a named HEEx component for consistent styling. https://x.com/jskalc/status/1843622806241575360 (https://x.com/jskalc/status/1843622806241575360?utm_source=thinkingelixir&utm_medium=shownotes) – LiveVue v0.5.0 release announcement, integrating Phoenix LiveView with the Vue framework. https://github.com/Valian/live_vue/tree/main (https://github.com/Valian/live_vue/tree/main?utm_source=thinkingelixir&utm_medium=shownotes) – GitHub repository for LiveVue, focusing on end-to-end reactivity with LiveView and Vue. https://github.com/woutdp/live_svelte (https://github.com/woutdp/live_svelte?utm_source=thinkingelixir&utm_medium=shownotes) – GitHub repository for LiveSvelte, an integration for reactivity with Svelte and LiveView. https://wout.space/notes/live-svelte (https://wout.space/notes/live-svelte?utm_source=thinkingelixir&utm_medium=shownotes) – Notes on LiveSvelte, detailing its usage and benefits for reactive interfaces. https://www.jonashietala.se/blog/2024/10/08/writinghomeassistantautomationsusinggenserversin_elixir/ (https://www.jonashietala.se/blog/2024/10/08/writing_home_assistant_automations_using_genservers_in_elixir/?utm_source=thinkingelixir&utm_medium=shownotes) – Blog post by Jonas Hietala on implementing HomeAssistant automations using Elixir GenServers. https://x.com/bernheisel/status/1843276992437010566 (https://x.com/bernheisel/status/1843276992437010566?utm_source=thinkingelixir&utm_medium=shownotes) – David Bernheisel shared his appearance on Elixir Friends podcast with German Velasco. https://share.transistor.fm/s/1e964a13 (https://share.transistor.fm/s/1e964a13?utm_source=thinkingelixir&utm_medium=shownotes) – Podcast episode featuring David Bernheisel discussing various programming topics and life experiences. Do you have some Elixir news to share? Tell us at @ThinkingElixir (https://twitter.com/ThinkingElixir) or email at show@thinkingelixir.com (mailto:show@thinkingelixir.com) Find us online - Message the show - @ThinkingElixir (https://twitter.com/ThinkingElixir) - Message the show on Fediverse - @ThinkingElixir@genserver.social (https://genserver.social/ThinkingElixir) - Email the show - show@thinkingelixir.com (mailto:show@thinkingelixir.com) - Mark Ericksen - @brainlid (https://twitter.com/brainlid) - Mark Ericksen on Fediverse - @brainlid@genserver.social (https://genserver.social/brainlid) - Dave Lucia - @davydog187 (https://twitter.com/davydog187)

Taiwanese writer Chi Ta-wei (紀大偉)'s 1996 novel “The Membranes” has seen global success in recent years, with translations in French, English, Japanese, Korean, Spanish, Italian, Finnish, Spanish, Danish, and forthcoming editions in Portuguese, Greek, and Vietnamese. “The Membranes” is a dystopian fiction set in the 22nd century. Climate change has devastated Earth, and humans now live at the bottom of the sea. The protagonist is a dermatologist named Momo who can read her clients' memories through their skins. Chi Ta-wei is an important voice in Taiwanese queer literature.  We talk about the year 1994 - the era of Pulp Fiction, Nine Inch Nails, and Nirvana. In Taipei, a bookstore called FemBooks (女書店) was opened. Artists and students wanting international cinema flocked to the Golden Horse Film Festival.  One of Ta-wei's contemporaries is the late author Qiu Miaojin (邱妙津). Ta-wei talks about why he and Qiu shared a fondness for Europe. We also talk about the Australian writer and translator Ari Heinrich who worked on English translations for both Chi Ta-wei and Qiu Miaojin. Chi Ta-Wei also talks about his appreciation for translators, and advice for writers, editors, and publishers who are working on bringing Taiwanese books to the world.  For French listeners, here's our Interview with theater director Cédric Delorme-Bouchard on the stage adaptation that premiered in Montreal 2024: https://ghostisland.media/en/shows/france-taiwan/membrane-cedric-delorme-bouchard More on Chi Ta-wei: www.taweichi.com/ Links to the novel “The Membranes”: (In English) “The Membranes” translated by Ari Heinrich (University of Columbia Press, 2021) - https://cup.columbia.edu/book/the-membranes/9780231195713 (En français) “Membrane” traduit par Gwennaël Gaffric (L'Asiathèque. 2020) https://www.asiatheque.com/fr/livre/membrane 《膜》繁體中文版 (聯經出版, 1996) https://www.linkingbooks.com.tw/LNB/book/Book.aspx?ID=184182&vs=pc Tag and follow Ghost Island Media on social media: Instagram | Facebook | Twitter Support us by donating on Patreon - http://patreon.com/taiwan  EPISODE CREDIT Host / Emily Y. Wu @emilyywuEditing / Zack Chiang, Wayne TsaiResearcher / Skylar NguyenA Ghost Island Media production / @ghostislandmeSupport the show: https://patreon.com/TaiwanSee omnystudio.com/listener for privacy information.

News includes a proof of concept for Phoenix Sync by José Valim, exciting new developments in Elixir's type system, Algora.tv's open-source Twitch for developers, Sean Moriarity's insights on the future of Nx, Axon, and Bumblebee, a powerful new feature in Livebook integrating with Fly.io, and more! Show Notes online - http://podcast.thinkingelixir.com/219 (http://podcast.thinkingelixir.com/219) Elixir Community News - https://github.com/josevalim/sync (https://github.com/josevalim/sync?utm_source=thinkingelixir&utm_medium=shownotes) – Phoenix Sync - A proof of concept of an Elixir/Phoenix node that runs PostgreSQL Replication to synchronize data with clients, as showcased at ElixirConf US 2024 keynote by José Valim. - https://x.com/TylerAYoung/status/1829248168908968220 (https://x.com/TylerAYoung/status/1829248168908968220?utm_source=thinkingelixir&utm_medium=shownotes) – Tyler Young's Twitter thread discussing the big idea behind Phoenix Sync which involves frontend applications syncing with backend using Phoenix channels and logical replication. - https://elixir-lang.org/blog/2024/08/28/typing-lists-and-tuples/ (https://elixir-lang.org/blog/2024/08/28/typing-lists-and-tuples/?utm_source=thinkingelixir&utm_medium=shownotes) – New ElixirLang blog post exploring how various Elixir idioms interact with the upcoming type system, especially focusing on lists and tuples. - https://x.com/josevalim/status/1829537976378159139 (https://x.com/josevalim/status/1829537976378159139?utm_source=thinkingelixir&utm_medium=shownotes) – José Valim's Twitter post about the mathematical soundness of set-theoretic types as discussed in the latest ElixirLang blog post. - https://github.com/algora-io/tv (https://github.com/algora-io/tv?utm_source=thinkingelixir&utm_medium=shownotes) – Algora.tv is trending as an open-source Twitch for developers using Membrane for real-time video processing. - https://dockyard.com/blog/2024/08/20/where-are-nx-axon-bumblebee-headed (https://dockyard.com/blog/2024/08/20/where-are-nx-axon-bumblebee-headed?utm_source=thinkingelixir&utm_medium=shownotes) – Sean Moriarity's blog post on DockYard discussing the current state of the AI space and future directions for Nx, Axon, and Bumblebee. - https://github.com/elixir-nx/nx/commit/ab8261180cd54ca95c0c34035a5380ade2805afb (https://github.com/elixir-nx/nx/commit/ab8261180cd54ca95c0c34035a5380ade2805afb?utm_source=thinkingelixir&utm_medium=shownotes) – José Valim's commit in Nx demonstrating how few lines of code are required to support compiling a machine learning model in one node and sending it to another for execution using Erlang erpc module. - https://x.com/cigrainger/status/1829822647489728679 (https://x.com/cigrainger/status/1829822647489728679?utm_source=thinkingelixir&utm_medium=shownotes) – New Livebook feature shared online integrates with Fly.io platform to run local notebooks on arbitrary hardware with a few clicks, allowing scalability and elasticity. - https://x.com/josevalim/status/1828781593387004065 (https://x.com/josevalim/status/1828781593387004065?utm_source=thinkingelixir&utm_medium=shownotes) – Image from Chris McCord's talk showing a Livebook connecting to a production node and getting intellisense for remote node code. - https://elixirstatus.com/p/wmpxg-code-beam-america-2025-call-for-talks-is-open- (https://elixirstatus.com/p/wmpxg-code-beam-america-2025-call-for-talks-is-open-?utm_source=thinkingelixir&utm_medium=shownotes) – Call for Talks for CodeBEAM America 2025 is open. Deadline for proposals is October 20, 2024. Conference dates are March 6-7, 2025, in San Francisco and Online. - https://codebeamamerica.com/#cft (https://codebeamamerica.com/#cft?utm_source=thinkingelixir&utm_medium=shownotes) – Official site for CodeBEAM America 2025 Call for Talks. - https://codebeamnyc.com/ (https://codebeamnyc.com/?utm_source=thinkingelixir&utm_medium=shownotes) – CodeBEAM NYC conference on November 15th, a one-day event. - Reflections on ElixirConf discussion. Do you have some Elixir news to share? Tell us at @ThinkingElixir (https://twitter.com/ThinkingElixir) or email at show@thinkingelixir.com (mailto:show@thinkingelixir.com) Find us online - Message the show - @ThinkingElixir (https://twitter.com/ThinkingElixir) - Message the show on Fediverse - @ThinkingElixir@genserver.social (https://genserver.social/ThinkingElixir) - Email the show - show@thinkingelixir.com (mailto:show@thinkingelixir.com) - Mark Ericksen - @brainlid (https://twitter.com/brainlid) - Mark Ericksen on Fediverse - @brainlid@genserver.social (https://genserver.social/brainlid) - David Bernheisel - @bernheisel (https://twitter.com/bernheisel) - David Bernheisel on Fediverse - @dbern@genserver.social (https://genserver.social/dbern)

Show notes at pharmacyjoe.com/episode946. In this episode, I'll discuss the effects of calcium during treatment of hyperkalemia. The post 946: Animal data suggest calcium does not stabilize the cardiac membrane in hyperkalemia appeared first on Pharmacy Joe.

This week, Quinta and Scott were joined by Lawfare Managing Editor Tyler McBrien and Lawfare Contributing Editor Eric Ciaramella to talk over all the national security news causing traffic issues in D.C., including:“Ukraine in the Membrane.” NATO is hosting its 75th anniversary summit here in Washington, D.C., this week. But its members' eyes are uniformly locked on Ukraine, whose (eventual) membership several will voice support for this week—even as others worry about what a future Trump administration might mean for the alliance and its commitment to the ongoing conflict there. What trajectory is NATO headed on? And what should the alliance be doing to prepare?“So Gauche.” Left political movements emerged victorious over populist right-wing movements in two major elections in Europe this past week. In France, the left-wing New Popular Front squeaked out a narrow plurality over President Emmanuel Macron's centrist coalition and the right-wing National Rally. And in the U.K., a resurgent Labour movement finally ended fourteen years of increasingly unpopular Conservative control. What do these results tell us about political trends in Europe? And can they shed any light on what the United States might experience in its own election later this year?“Hindsight is 20/25.” This week, former President Donald Trump tried to distance himself from Project 2025, denying any awareness of the Heritage Foundation-led project that has produced a 900-page book of policy proposals for the potentially returning conservative president—even though several of his former advisers contributed to the project and a number of its proposals seem to be included in the platform that Republican Party leaders adopted this week. How does this agenda compare to what the Trump administration pursued in its first term? And what role is it likely to play if Trump does return to the White House?For object lessons, Quinta recommended James McBride's latest book, “The Heaven & Earth Grocery Store.” Scott highlighted two great pieces on the continuing relevance of the classic movie “Chinatown,” in light of both its 50th anniversary and the death of its author Robert Towne—and urged director David Fincher to keep at his plans to produce a prequel series for Netflix. Tyler shared the earnest welcome to the NATO summit produced by D.C.'s own wholesome influencer, Tony P. And Eric expressed his passion for the great Finnish pastime of hobby horsing.To receive ad-free podcasts, become a Lawfare Material Supporter at www.patreon.com/lawfare. You can also support Lawfare by making a one-time donation at https://givebutter.com/c/trumptrials.Support this show http://supporter.acast.com/lawfare. Hosted on Acast. See acast.com/privacy for more information.

This week, Quinta and Scott were joined by Lawfare Managing Editor Tyler McBrien and Lawfare Contributing Editor Eric Ciaramella to talk over all the national security news causing traffic issues in D.C., including:“Ukraine in the Membrane.” NATO is hosting its 75th anniversary summit here in Washington, D.C., this week. But its members' eyes are uniformly locked on Ukraine, whose (eventual) membership several will voice support for this week—even as others worry about what a future Trump administration might mean for the alliance and its commitment to the ongoing conflict there. What trajectory is NATO headed on? And what should the alliance be doing to prepare?“So Gauche.” Left political movements emerged victorious over populist right-wing movements in two major elections in Europe this past week. In France, the left-wing New Popular Front squeaked out a narrow plurality over President Emmanuel Macron's centrist coalition and the right-wing National Rally. And in the U.K., a resurgent Labour movement finally ended fourteen years of increasingly unpopular Conservative control. What do these results tell us about political trends in Europe? And can they shed any light on what the United States might experience in its own election later this year?“Hindsight is 20/25.” This week, former President Donald Trump tried to distance himself from Project 2025, denying any awareness of the Heritage Foundation-led project that has produced a 900-page book of policy proposals for the potentially returning conservative president—even though several of his former advisers contributed to the project and a number of its proposals seem to be included in the platform that Republican Party leaders adopted this week. How does this agenda compare to what the Trump administration pursued in its first term? And what role is it likely to play if Trump does return to the White House?For object lessons, Quinta recommended James McBride's latest book, “The Heaven & Earth Grocery Store.” Scott highlighted two great pieces on the continuing relevance of the classic movie “Chinatown,” in light of both its 50th anniversary and the death of its author Robert Towne—and urged director David Fincher to keep at his plans to produce a prequel series for Netflix. Tyler shared the earnest welcome to the NATO summit produced by D.C.'s own wholesome influencer, Tony P. And Eric expressed his passion for the great Finnish pastime of hobby horsing.To receive ad-free podcasts, become a Lawfare Material Supporter at www.patreon.com/lawfare. You can also support Lawfare by making a one-time donation at https://givebutter.com/c/trumptrials. Hosted on Acast. See acast.com/privacy for more information.