Podcasts about outcomes

Today, Dave Furfaro, Luke Hedrick, and Robert Wharton discuss the PREDMETH trial published in The New England Journal of Medicine in 2025. This was a non-inferiority trial comparing prednisone to methotrexate for upfront therapy in treatment-naive sarcoidosis patients. Listen in for a break down of the trial, analysis, and clinically applicable pearls. Article and Reference Todays’ episode discusses the PREDMETH trial published in NEJM in 2025. Kahlmann V, Janssen Bonás M, Moor CC, Grutters JC, Mostard RLM, van Rijswijk HNAJ, van der Maten J, Marges ER, Moonen LAA, Overbeek MJ, Koopman B, Loth DW, Nossent EJ, Wagenaar M, Kramer H, Wielders PLML, Bonta PI, Walen S, Bogaarts BAHA, Kerstens R, Overgaauw M, Veltkamp M, Wijsenbeek MS; PREDMETH Collaborators. First-Line Treatment of Pulmonary Sarcoidosis with Prednisone or Methotrexate. N Engl J Med. 2025 Jul 17;393(3):231-242. doi: 10.1056/NEJMoa2501443. Epub 2025 May 18. PMID: 40387020. https://www.nejm.org/doi/full/10.1056/NEJMoa2501443 Meet Our Hosts Luke Hedrick is an Associate Editor at Pulm PEEPs and runs the Rapid Fire Journal Club Series. He is a senior PCCM fellow at Emory, and will be starting as a pulmonary attending at Duke University next year. Robert Wharton is a recurring guest on Pulm PEEPs as a part of our Rapid Fire Journal Club Series. He completed his internal medicine residency at Mt. Sinai in New York City, and is currently a first year pulmonary and critical care fellow at Johns Hopkins. Key Learning Points Clinical context Prednisone remains the traditional first-line treatment for pulmonary sarcoidosis when treatment is indicated, with evidence for short-term improvements in symptoms, radiographic findings, and pulmonary function—but with substantial, familiar steroid toxicities (weight gain, insomnia, HTN/DM, infection risk, etc.). Despite widespread use, glucocorticoids haven't been robustly tested head-to-head against many alternatives as initial therapy, and evidence for preventing long-term decline (especially in severe disease) is limited. Immunosuppressants (like methotrexate) are often used as steroid-sparing agents, but guideline recommendations are generally conditional/low-quality evidence, and practice varies. Why PREDMETH matters It addresses a real-world question: Can methotrexate be an initial alternative to prednisone in pulmonary sarcoidosis, rather than being reserved only for steroid-sparing later? It also probes a common clinical belief: MTX has slower onset than prednisone (often assumed, not well-proven). Trial design (what to know) Open-label, randomized, noninferiority trial across 17 hospitals in the Netherlands. Included patients with pulmonary sarcoidosis who had a clear pulmonary indication to start systemic therapy (moderate/severe symptoms plus objective risk features like reduced FVC/DLCO or documented decline, plus parenchymal abnormalities). Excluded: non–treatment-naïve patients and those whose primary indication was extrapulmonary disease. Treat-to-tolerability with escalation: both drugs started low and were slowly increased; switch/add-on allowed for inadequate efficacy or unacceptable side effects. Primary endpoint: change in FVC (with the usual caveat that FVC is “objective-ish,” but effort-dependent and not always patient-centered). Noninferiority margin: 5% FVC, justified as within biologic/measurement variation and “not clinically relevant.” Outcomes assessed at weeks 4, 16, 24; powered for ~110 patients to detect the NI margin. Patient population (who this applies to) Mostly middle-aged (~40s) with mild-to-moderate physiologic impairment on average (FVC ~77% predicted; DLCO ~70% predicted). Netherlands-based cohort with limited Black representation (~7%), which matters for generalizability. Would have been helpful to know more about comorbidities (e.g., diabetes), which can strongly influence prednisone risk. Main findings (what happened) Methotrexate was noninferior to prednisone at week 24 for FVC: Between-group difference in least-squares mean change at week 24: −1.17 percentage points (favoring prednisone) with CI −4.27 to +1.93, staying within the 5% NI margin. Timing mattered: Prednisone showed earlier benefit (notably by week 4) in FVC and across quality-of-life measures. By week 24, those early differences largely washed out—possibly because MTX “catches up,” and/or because crossover increased over time. In their reporting, MTX didn't meet noninferiority for FVC until week 24, supporting the practical message that prednisone works faster. Crossover and analysis nuance (important for interpretation) Crossover was fairly high, which complicates noninferiority interpretation: MTX arm: some switched to prednisone for adverse events and others had prednisone added for disease progression/persistent symptoms. Prednisone arm: some had MTX added. In noninferiority trials, heavy crossover can bias intention-to-treat analyses toward finding “no difference” (making noninferiority easier to claim). Per-protocol analyses avoid some of that but introduce other biases. They reported both. Safety signals (what to remember clinically) Adverse events were very common in both arms (almost everyone), mostly mild. Side-effect patterns fit expectations: Prednisone: more insomnia (and classic steroid issues). MTX: more headache/cough/rash, and notably liver enzyme elevations (about 1 in 4), with a small number discontinuing. Serious adverse events were rare; numbers were too small to confidently separate “signal vs noise,” but overall known risk profiles apply. Limitations (why you shouldn't over-read it) Open-label design, and FVC—while objective-ish—is still effort-dependent and can be influenced by expectation/behavior. Small trial, limiting subgroup conclusions (e.g., severity strata, different phenotypes). Generalizability issues (Netherlands demographics; US populations have higher rates of obesity/metabolic syndrome, which may tilt the steroid risk-benefit equation). Crossover reduces precision and interpretability of between-group differences over time. Practice implications (the “so what”) For many patients with pulmonary sarcoidosis needing systemic therapy, MTX is a reasonable initial alternative to prednisone when thinking long-term tolerability and steroid avoidance. Prednisone likely provides faster symptom/QoL relief in the first weeks—so it may be preferable when rapid improvement is important. The trial strengthens the case for a patient-centered discussion: short-term relief vs side-effect tradeoffs, and the possibility of early combination therapy in more severe cases (suggested, not proven).

Bill Saltmarsh joins me to discuss where a modern CDO gets the inspiration to “operate in the producty way” in his domain, which is healthcare. Now Vice President of Enterprise Data and Transformation and the Chief Data Officer at Children's Mercy Kansas City, his early days as an analyst revealed a gap between what stakeholders asked for vs. the outcomes they sought. This convinced him that data teams need to pause, ask better questions, and prioritize meaningful outcomes over quickly churning out dashboards and reports. Bill and I discuss how a producty mindset can be embedded across an organization. He also talks about why data leaders must set firm expectations. We explore the personal and cultural shifts needed for analysts and data scientists to embrace design, facilitation, and deeper discovery, even when it initially seems to slow things down. We also examine how to define value and ROI in healthcare, where a data team's impact is often indirect.  By tying data efforts to organizational OKRs and investing in governance, strong data foundations, and data literacy, he argues that analytics, data, and AI can drive better decisions, enhance patient care, and create durable organizational value. Highlights/ Skip to: What led Bill Saltmarsh to run his team at Children's Mercy “the producty way” (1:42)  The kinds of environments Bill worked in prior that influenced his current management philosophy (4:36) Why data teams shouldn't be report factories (6:37)  Setting the standard at the leadership level vs the everyday work (10:53) How Bill is skilling and hiring for non-technical skills (i.e. product, design, etc) (13:51)  Patterns that data professionals go through to know if they're guiding stakeholders correctly (20:54)  The point when Bill has to think about the financial side of the hospital (26:30) How Bill thinks about measuring the data team's  contributions to the hospital's success (30:28) Bill's philosophy on generative AI (36:00) Links Bill Saltmarsh on LinkedIn

Incremental growth in the future across ecommerce and agentic commerce will be unlocked by two major AI-driven trends - increased scale with increased specificity. Higher discovery driven by specific use cases, higher conversion rates through personalized experiences, and delivered on vastly more endpoints and agentic conversations. To be part of these trends early means taking some big bets on AI transformation. The question is how? John Rossman, Author of Big Bet Leadership: Your Transformation Playbook for Winning in the Hyper-Digital Era, joins the podcast for a delicious conversation on the stack of pancakes you need to cook up to transform for seizing competitive advantage in the AI era.

This week we go back in time 2 years to review a recent paper from 2023 about outcomes of cardiac transplantation in the adult congenital heart patient (ACHD). Little has been written on this topic until this very robust and large scale report. How do single ventricle ACHD patients fair at transplant and how do they compare to non-ACHD heart transplant recipients? Why might 1 and 3 year outcomes not be a 'fair' method of assessing outcomes in this very high risk patient group? How do HLHS patient outcomes compare with other single ventricles? Are there better ways to measure risk in this patient group and how might the data in this work inform risk stratification and management of failing Fontan patients in whom transplantation is being considered? These are amongst the questions posed this week to the week's expert, Dr Daphne Hsu who is Professor of Pediatrics at the Albert Einstein College of Medicine at The Children's Hospital at Montefiore.https://doi.org/10.1016/j.jacc.2023.06.037For those interested in learning more about Dr. Hsu, take a listen to episode #166 from June, 2021:https://www.spreaker.com/episode/pediheart-podcast-166-a-conversation-with-professor-daphne-hsu--45144274

Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, and Preeti Malani, MD, MSJ, Deputy Editor of JAMA, the Journal of the American Medical Association, for articles published from December 13-19, 2025.

How well are you managing patients on EGFR inhibitor therapies in your clinical practice? Credit available for this activity expires: 12/18/26 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/person-centered-care-egfr-mutated-advanced-nsclc-optimizing-2025a1000xxa?ecd=bdc_podcast_libsyn_mscpedu

Mitigation Specialist and President of the Connecticut Women's Consortium Dr. Jozlyn Hall joins us to talk about the scope of her work as a member of the criminal defense team and how it impacts sentencing in cases before the court Originally used solely in capital cases, it is not about excusing individuals of the responsibility of their actions, but for getting the accused the assistance they need based on a complete evaluation of their strengths, deficits and needs. Given that the needs may include SUD services, it is an important area for professionals working with justice-involved individuals to understand.

  We are continuing our miniseries where we pay tribute to one of my favorite podcasts, Revisionist History, hosted by the well-known author Malcolm Gladwell. Gladwell describes Revisionist History as a podcast about things overlooked and misunderstood. There are many injuries or problems we see in the office or on the sidelines that patients, parents, coaches, and even health care professionals give a generic label or diagnosis. In some situations, it may be correct, but often things get lumped into a simple category which may lead to things not being treated or managed most effectively. This is episode 5 of this series I am affectionately calling “Revisionist Sports Medicine”, a series about things in Pediatric Sports Medicine overlooked or misunderstood.   Connect with The Host! Subscribe to This Podcast Now!     The ultimate success for every podcaster – is FEEDBACK! Be sure to take just a few minutes to tell the hosts of this podcast what YOU think over at Apple Podcasts! It takes only a few minutes but helps the hosts of this program pave the way to future greatness! Not an Apple Podcasts user? No problem! Be sure to check out any of the other many growing podcast directories online to find this and many other podcasts via The Podcaster Matrix!     Housekeeping -- Get the whole story about Dr. Mark and his launch into this program, by listing to his "101" episode that'll get you educated, caught up and in tune with the Doctor that's in the podcast house! Listen Now! -- Interested in being a Guest on The Pediatric Sports Medicine Podcast? Connect with Mark today!     Links from this Episode: -- Dr. Mark Halstead: On the Web -- On X -- Dr. Martin Boyer https://www.ortho.wustl.edu/content/Patient-Care/2627/Find-a-Physician/Physician-Directory/Martin-Boyer-MD-FRCSC/Bio.aspx Compton J, Wall LB, Romans S, Goldfarb CA. Outcomes of Acute Repair Versus Nonrepair of Zone I Flexor Digitorum Profundus Tendon Injuries. J Hand Surg Am. 2023 Aug;48(8):832.e1-832.e6. doi: 10.1016/j.jhsa.2022.02.005. Epub 2022 Apr 9. PMID: 35414448. https://pubmed.ncbi.nlm.nih.gov/35414448/ Torry Holt Finger https://www.foxsports.com/watch/1429525571619 Jammed Finger (MedScape) https://emedicine.medscape.com/article/98081-overview     Calls to the Audience Inside this Episode: -- Be sure to interact with the host, send detailed feedback via our customized form and connect via ALL of our social media platforms! Do that over here now! -- Interested in being a guest inside The Pediatric Sports Medicine Podcast with Dr. Mark? Tell us now! -- Ready to share your business, organization or efforts message with Dr. Mark's focused audience? Let's have a chat! -- Do you have feedback you'd like to share with Dr. Mark from this episode? Share YOUR perspective!   Be an Advertiser/Sponsor for This Program!   Tell Us What You Think! Feedback is the cornerstone and engine of all great podcast. Be sure to chime in with your thoughts, perspective sand more.  Share your insight and experiences with Dr. Mark by clicking here!   The Host of this Program: Mark Halstead:  Dr. Mark Halstead received his medical degree from the University of Wisconsin Medical School. He stayed at the University of Wisconsin for his pediatric residency, followed by a year as the chief resident. Following residency, he completed a pediatric and adult sports medicine fellowship at Vanderbilt University. He has been an elected member to the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness and the Board of Directors of the American Medical Society for Sports Medicine (AMSSM). He has served as a team physician or medical consultant to numerous high schools, Vanderbilt University, Belmont University, Washington University, St. Louis Cardinals, St. Louis Blues, St. Louis Athletica, and St. Louis Rams. He serves and has served on many local, regional and national committees as an advisor for sports medicine and concussions. Dr. Halstead is a national recognized expert in sport-related concussions and pediatric sports medicine. — Dr. Mark Halstead on Facebook — Dr. Mark Halstead on LinkedIn — Dr. Mark Halstead on X — Learn Why The Pediatric Sports Medicine Podcast Exists...     Martin Boyer:  Dr. Martin Boyer is a professor of orthopedics at Washington University School of Medicine. Born in Montreal, Dr. Boyer graduated first in his medical school class at the University of Toronto and completed his orthopedic surgery residency there as well, where he was named most outstanding graduate. He completed two hand surgical fellowships at Sunnybrook Health Sciences Center in Toronto and at the Indiana University Hand Center. He served as president of the American Society for Surgery of the Hand, and he has made St. Louis and Washington University his home since 1997, where he's also been named the Clinical Teacher of the Year over 10 times. Connect with Dr. Martin Boyer: https://www.ortho.wustl.edu/content/Patient-Care/2627/Find-a-Physician/Physician-Directory/Martin-Boyer-MD-FRCSC/Bio.aspx      

In this podcast, Isabella Christovão discusses her paper 'Outcomes and standardized tools in telehealth physical therapy for children with cerebral palsy: A scoping review using the ICF framework'.   The paper is available here: https://doi.org/10.1111/dmcn.70006   Follow DMCN on Podbean for more:  https://dmcn.podbean.com/ ___ Watch DMCN Podcasts on YouTube: https://bit.ly/2ONCYiC __ DMCN Journal: Developmental Medicine & Child Neurology (DMCN) has defined the field of paediatric neurology and childhood-onset neurodisability for over 60 years. DMCN disseminates the latest clinical research results globally to enhance the care and improve the lives of disabled children and their families.   DMCN Journal - https://onlinelibrary.wiley.com/journal/14698749 ___ Find us on Twitter! @mackeithpress - https://twitter.com/mackeithpress

In this podcast, Lorena C. Ferreira discusses her paper 'Outcomes and standardized tools in telehealth physical therapy for children with cerebral palsy: A scoping review using the ICF framework'.  The paper is available here: https://doi.org/10.1111/dmcn.70006 Follow DMCN on Podbean for more:  https://dmcn.podbean.com/  ___ Watch DMCN Podcasts on YouTube: https://bit.ly/2ONCYiC __ DMCN Journal: Developmental Medicine & Child Neurology (DMCN) has defined the field of paediatric neurology and childhood-onset neurodisability for over 60 years. DMCN disseminates the latest clinical research results globally to enhance the care and improve the lives of disabled children and their families. DMCN Journal - https://onlinelibrary.wiley.com/journal/14698749 ___ Find us on Twitter! @mackeithpress - https://twitter.com/mackeithpress

In today's episode, we had the pleasure of speaking with Pooja M. Phull, MD, a hematologist/oncologist at the John Theurer Cancer Center at Hackensack University Medical Center in New Jersey, about emerging insights into the gut microbiome and its clinical relevance in multiple myeloma. Dr Phull discussed how microbial composition—particularly the presence of butyrate-producing bacteria—may influence therapeutic responsiveness, sustained minimal residual disease negativity, and long-term outcomes for patients undergoing autologous stem cell transplantation. In our exclusive interview, Dr Phull reviewed findings from a translational study that longitudinally profiled the fecal microbiome of patients with newly diagnosed myeloma, highlighting the significant post-transplant depletion of beneficial short-chain, fatty acid–producing organisms and its association with inferior progression-free survival. She also outlined supportive laboratory and in vivo data demonstrating the antitumor effects of butyrate and discussed how microbiome profiling may serve as both a predictive biomarker and a potential therapeutic target. Additionally, Dr Phull explored how dietary patterns, lifestyle factors, and antibiotic stewardship may contribute to preserving gut microbial health, and she emphasized the growing need for prospective studies to clarify how these interventions could enhance treatment outcomes for patients with active myeloma and precursor conditions such as monoclonal gammopathy of undetermined significance and smoldering myeloma.

You're listening to American Ground Radio with Stephen Parr and Louis R. Avallone. This is the full show for December 17, 2025. 0:30 Breaking news out of Washington: FBI Deputy Director Dan Bongino is set to leave the Bureau early next year — and while this isn’t a scandal, it is a moment worth watching. Bongino’s short tenure at the FBI raises real questions about leadership, culture, and whether outspoken media figures can thrive inside a process-heavy federal agency. We dive into why Bongino may be better suited for influence behind a microphone than inside the bureaucracy, what his exit signals for FBI Director Kash Patel and Attorney General Pam Bondi, and how recent FBI wins and missteps factor into the bigger picture. 9:00 Plus, we cover the Top 3 Things You Need to Know. President Trump has ordered a Naval blockade of Venezuela. Four Republican broke from their party to force a house vote on extending Democrat designed subsidies for the Democrat designed Affordable Care Act. Republican Congressman Dan Newhouse is not seeking reelection to Congress next year. 11:30 Get Prodovite Plus from Victory Nutrition International for 20% off. Go to vni.life/agr and use the promo code AGR20. 12:00 A new YouGov poll exposes a sharp political divide on immigration — and the numbers are hard to ignore. Only 17 percent of Democrats say legal immigration should be reduced, compared to 66 percent of Republicans who want it cut back or ended altogether. We dig into what those numbers really mean, the difference between legal and illegal immigration, and why border enforcement has become a breaking point even for many Democrats after the Biden administration’s failures. 15:00 American Mamas Teri Netterville and Kimberly Burleson take on the controversy surrounding Trump Chief of Staff Susie Wiles and her decision to sit down with Vanity Fair — and why many conservatives see it as a major miscalculation. We break down how a year-long interview turned into headline-grabbing quotes about Trump, JD Vance, and the White House inner circle, how off-the-record trust was allegedly weaponized, and why legacy media outlets are viewed as hostile territory for Republicans. The Mamas also unpack media bias, selective framing, and the broader lesson about walking into the “lion’s den” of left-leaning press — even when you think you’re being careful. If you'd like to ask our American Mamas a question, go to our website, AmericanGroundRadio.com/mamas and click on the Ask the Mamas button. 22:00 We dive into reports of new plaques placed beneath presidential portraits in the White House — and the controversy they’ve sparked. Do these bronze plaques represent historical record or political trolling? And where the line is between blunt truth-telling and misuse of taxpayer dollars? We discuss President Trump’s unapologetic style, the difference between opinion and history, and whether America’s obsession with politeness has replaced honest evaluation of past presidents. 25:30 We Dig Deep into the nation’s largest teachers union after reports that the NEA is promoting so-called “neo-pronouns” and “zeo-pronouns” in teacher training sessions. This isn’t education reform — it’s ideological activism replacing basic grammar, clarity, and classroom priorities. We question why unions are focusing on made-up language and identity politics instead of improving student outcomes, and warning that redefining words isn’t about communication but control. 31:00 Get TrimROX from Victory Nutrition International for 20% off. Go to vni.life/agr and use the promo code AGR20. 31:30 We break down President Trump's prime-time address, and it's a deliberate moment of leadership where he plans to highlight his administration’s accomplishments and preview what he calls America’s “golden age.” Speaking directly to the nation on major networks still matters, even in an era dominated by social media. 34:00 And we have a Bright Spot from Florida, where the state can now enforce a ban on sexually explicit drag performances in front of minors. It's a long-overdue correction, and should never have been treated as protected speech when children were involved. We break down court battle that led to the decision, the narrow exception that still exists, and the broader cultural fight over bringing adult performance art into kids’ spaces like libraries and classrooms. This isn’t about censoring adults, it's about drawing a clear line between free speech and exposing children to sexualized content — a line that should have never been blurred in the first place. 38:30 In Texas, Republican Senate candidate Wesley Hunt is pushing a proposal to block education benefits for illegal immigrants — a move that's long overdue. With millions of illegal immigrants already in the country, full deportation isn’t realistic. Self-deportation was always part of the strategy. By cutting off benefits like public education, families will choose to leave on their own. It's a tough, controversial approach — but one that finally confronts why illegal immigration persists in the first place. 40:30 And we finish off today’s show with a little tech history that quietly reshaped the modern world. On this day in 1994, Netscape Navigator 1.0 hit the market and opened the door for everyday people to actually use the internet. Long before Chrome, Safari, or Firefox, Netscape was how the web worked — the browser that made surfing possible and set the standard for everything that followed. Follow us: americangroundradio.com Facebook: facebook.com / AmericanGroundRadio Instagram: instagram.com/americangroundradioSee omnystudio.com/listener for privacy information.

Join Professor Iain McInnes for the latest episode of Discussing RA on The Immune-Mediated Inflammatory Disease Forum. In this episode, he and Doctor Reike Alten will be reviewing two papers. The first paper by Kameda et al. assessed long-term safety and efficacy of UPA over 5 years in Japanese patients with moderate-to- severe active RA and an inadequate response to stable doses of csDMARDs-IR. The second paper by Salvato et al. assessed the impact of chronic oral low-dose GCs on the efficacy and retention rates of JAK inhibitors compared to other mechanisms of action therapies in a cohort of RA patients with inadequate response to TNFi.

Organizations are increasingly leveraging AI-powered platforms to understand and reduce their carbon emissions.Creating innovative, sustainable settlements that integrate nature and human habitats is crucial to reversing biodiversity decline.Employee ownership trusts can incentivize long-term stewardship and success of service-based companies.Please contact Will @ will.richardson@51tocarbonzero.com

Traditional ABM frameworks are no longer enough.In this episode of the OnBase podcast, Paul Gibson sits down with Declan Mulkeen, CMO at Strategic ABM, to explore how modern ABM strategies are evolving toward outcomes, relevance, and long-term customer value.They discuss why customers do not buy “ABM models,” how buying groups should really be approached, the role of AI in accelerating insight without losing trust, and why lifetime value is becoming the most important metric for B2B growth.If you are rethinking your ABM approach or struggling to prove impact beyond marketing metrics, this conversation will change how you look at account-based marketing.About the GuestDeclan heads up Marketing at strategicabm. After some 20 years working as a CMO in the Professional Services, SaaS and EdTech sectors, Declan is now Agency-side building the strategicabm brand and running the Agency's successful ABM program. Declan is also the host of the leading ABM podcast, Let's talk ABM.Connect with Declan.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. Nasser Altorki, thoracic surgeon at Weill Cornell Medicine in New York, and thoracic surgeon and CTSNet Senior Editor Leanne Ashrafian about the 10-year results from the JCOG0802 trial. Chapters 00:00 Intro 02:56 JANS 1, Re-Repair vs Replacement 05:07 JANS 2, Mini Mitral Multicentre RCT 07:01 JANS 3, PERSEVERE Study 08:54 JANS 4, Parietal Pleurectomy vs Pleural Abrasion 11:38 Career Center 12:33 Video 1, Endoscopic Post-Infarction VSD Repair 14:11 Video 2, 3D Dor Procedure & MVR Huge LV Aneurysm 15:19 Video 3, Non-Cardioplegic Myo Protection Robotic 17:16 Nasser Altorki Interview, JCOG 45:16 Upcoming Events 47:20 Closing They discuss key aspects of the trial, including the noninferiority primary endpoint. Dr. Altorki shares his overall thoughts on the trial, and they also examine topics such as pulmonary function, lobar vs sublobar resection, and segmentectomy vs wedge resection. Additionally, they explore secondary primary lung cancer, the importance of thoracic surgeons presenting data to patients, and best practices for segmentectomy to ensure patient safety. They also examine good wedge resection vs bad wedge resection, planning for segmentectomy, and the future of lobectomy and segmentectomy.   Joel also highlights recent JANS articles on the outcomes of re-repair vs replacement after failed primary mitral regurgitation repair, minimally invasive thoracoscopically-guided right minithoracotomy vs conventional sternotomy for mitral valve repair, one-year results of novel aortic arch hybrid prosthesis for repair of acute DeBakey Type I dissection with malperfusion, and a meta-analysis of efficacy and safety of parietal pleurectomy vs pleural abrasion in treating spontaneous pneumothorax.  In addition, Joel explores endoscopic post-infarction VSD repair, 3D video-assisted endoscopic Dor procedure and MVR for post-infarction huge LV aneurysm, and non-cardioplegic myocardial protection for robotic mitral surgery. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Outcomes of Re-Repair Versus Replacement After Failed Primary Mitral Regurgitation Repair: STS Adult Cardiac Surgery Database Analysis  2.) Minimally Invasive Thoracoscopically-Guided Right Minithoracotomy Versus Conventional Sternotomy for Mitral Valve Repair: The UK Mini Mitral Multicentre RCT  3.) One-Year Results of Novel Aortic Arch Hybrid Prosthesis for Repair of Acute DeBakey Type I Dissection With Malperfusion: PERSEVERE Study  4.) A Meta-Analysis of Efficacy and Safety of Parietal Pleurectomy Versus Pleural Abrasion in Treating Spontaneous Pneumothorax  CTSNet Content Mentioned  1.) Endoscopic Post-Infarction VSD Repair  2.) Pushing Surgical Boundaries: 3D Video-Assisted Endoscopic Dor Procedure and MVR for Post-Infarction Huge LV Aneurysm  3.) Non-Cardioplegic Myocardial Protection for Robotic Mitral Surgery  Other Items Mentioned  1.) Instructional Video Competition  2.) 2025 Endoscopic Cardiac Surgeons Club Video Competition  3.) 2025 CTSNet Recruitment Guide   4.) Career Center   5.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

Managing effort or managing outcomes – which is best? Get it right and you get a ton of benefits – better team performance, happier staff, more time plus more. Get this right more than you peers, and you will enjoy better team performance, better pay and bonuses, higher status and more.  Get it wrong and team performance suffers, you have unmotivated staff and you have a lot less time available personally.  I share 7 factor and approaches to maximise the benefits you get from getting a better balance between focusing on effort or outcomes. The best managers get it right by considering each of these 7 factors. --- ---  What to focus on - managing activity or results – is not always easy. It can even harder when it you struggle in measuring activity or results. You can't manage what you can't measure.  I start by explaining exactly what we mean when we talk about managing activity or managing effort. This is when a manager focuses on managing each step in a series of steps to get an end desired result. One extreme of this is micro-managing.  Then I explain the difference between managing effort and managing results. This will help you focus on activity or results, or get a better balance between the two for everything you and your team does at work.  Why results matter more than activity comes down to results are end result of a lot of activity. If the results are good, the activity to get those results is very likely to be good too. Good activity doesn't always give you good results.  Finally, I take you through 7 factors you should consider every day in deciding about what balance you strike between managing effort or outcomes. There is rarely a right or wrong answer. There is certainly better or worse in terms of creating great team performance and impressive results.  If you have any questions on “Managing Effort or Outcomes. How The Best Managers Get It Right”, please email me at support:enhance.training and I will get back to you.  Jess Coles enhance.training 

The Industry Relations Podcast is now available on your favorite podcast player! Overview Rob Hahn and Greg Robertson dig into the escalating conflict between Zillow and MRED over private listing networks (PLNs), IDX rules, and Zillow's Listing Access Standards (ZLAS). What starts as a dispute over listing visibility quickly becomes a deeper conversation about power: who ultimately controls listing data—the MLS or the portal? The episode explores MRED's emails to brokers, Zillow's outreach for direct feeds, potential January disruptions, and why this fight could set a precedent for MLS–portal relationships nationwide.  Key Takeaways Zillow and MRED are on a collision course over whether Zillow can selectively exclude PLN listings while still receiving IDX feeds.  MRED argues selective exclusion violates its IDX rules; Zillow argues it owes transparency to sellers and consistency to its standards.  Emails suggest Zillow may pursue direct broker feeds, potentially bypassing the MLS if access is cut off.  The dispute is less about private listings themselves and more about control—"who runs Barter Town."  Outcomes range from MLS dominance, to Zillow dominance, to a hard-to-define compromise—with major implications for brokers, sellers, and other MLSs. Links Zillow stalemate with Chicago's MLS looks like it's coming to a head Mad Max Clip   Connect with Rob and Greg Rob's Website  Greg's Website    Watch us on YouTube   Our Sponsors: Cotality  Notorious VIP The Giant Steps Job Board    Production and Editing Services by Sunbound Studios

JHLT: The Podcast returns with an episode discussing the paper, "High Antiphospholipid Antibody Titers and Outcomes of Pulmonary Endarterectomy: A Single-Center Retrospective Observational Cohort Study," from the December issue of JHLT.   They are joined by the first author, Camille Miard, MD, and senior author, François Stéphan, MD, PhD, both from the cardiothoracic intensive care unit at Hôpital Marie Lannelongue in Paris.   The discussion explores: Whether antiphospholipid antibody titers could predict postoperative outcomes for CTEPH patients undergoing pulmonary endarterectomy (PEA) How APS patients differed from non-APS patients in the PEA cohort The changes in clinical practice at Marie Lannelongue after the study's findings   For the latest studies from JHLT, visit www.jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at www.ishlt.org/jhlt.   Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.

Bob Farrell, CEO of mPulse, is using digital technology, data analytics and AI to improve the relationship between health plans and their members in order to improve health outcomes and operational efficiency. Bob introduces the concept of HXI, Health Experience and Insights, as a framework that unites data, intelligence, and personalized communication to provide tools to enage members at the best time and by the preferred methods with appropriate information at the right time. Analyzing claims data enables plans to identify high-risk patients, promote preventive care, and build health literacy. Bob explains, "The mission of mPulse, and this has really been the mission of the company since its founding in 2015, is to improve the health outcomes of our customers' members and patients. So we're looking to close gaps in care. We're looking to increase literacy so that members and patients can understand their health plans. So providers can take charge of healthcare and improve those outcomes. And while we're doing that, we try to help our customers improve their operational efficiencies. Most of our customers are health plans and they range from small community plans to large nationals. The 60 largest plans are our customers. We have a wide array of customers and continue to expand on that base, both with new customers and by doing more with the customers that we have."   "Health plans are not known to be the early adopters of technology. So you're right. A lot of them are still transitioning from older ways of doing things. But in general, health plans have a huge trust issue with their members, and it has really resulted from a lack of engagement, a lack of positive experience. So we see a lot of health plans looking to embrace technology to improve the member experience, make sure that those members are getting outreach. Not just now and then, but during the whole course of their consumer health journey, so that they can be aware of what things they have available to them, so that they can easily adjudicate claims and easily find providers."    #mPulse #HXI #PersonalizedCare #HealthExperienceInsights #DigitalHealth mPulse.com Download the transcript here  

Bob Farrell, CEO of mPulse, is using digital technology, data analytics and AI to improve the relationship between health plans and their members in order to improve health outcomes and operational efficiency. Bob introduces the concept of HXI, Health Experience and Insights, as a framework that unites data, intelligence, and personalized communication to provide tools to enage members at the best time and by the preferred methods with appropriate information at the right time. Analyzing claims data enables plans to identify high-risk patients, promote preventive care, and build health literacy. Bob explains, "The mission of mPulse, and this has really been the mission of the company since its founding in 2015, is to improve the health outcomes of our customers' members and patients. So we're looking to close gaps in care. We're looking to increase literacy so that members and patients can understand their health plans. So providers can take charge of healthcare and improve those outcomes. And while we're doing that, we try to help our customers improve their operational efficiencies. Most of our customers are health plans and they range from small community plans to large nationals. The 60 largest plans are our customers. We have a wide array of customers and continue to expand on that base, both with new customers and by doing more with the customers that we have."   "Health plans are not known to be the early adopters of technology. So you're right. A lot of them are still transitioning from older ways of doing things. But in general, health plans have a huge trust issue with their members, and it has really resulted from a lack of engagement, a lack of positive experience. So we see a lot of health plans looking to embrace technology to improve the member experience, make sure that those members are getting outreach. Not just now and then, but during the whole course of their consumer health journey, so that they can be aware of what things they have available to them, so that they can easily adjudicate claims and easily find providers."    #mPulse #HXI #PersonalizedCare #HealthExperienceInsights #DigitalHealth mPulse.com Listen to the podcast here  

JCO PO author Dr. Shilpa Gupta at Cleveland Clinic Children's Hospital shares insights into her article, "Fibroblast Growth Factor Receptor 3 (FGFR3) Alteration Status and Outcomes on Immune Checkpoint Inhibitors (ICPI) in Patients with Metastatic Urothelial Carcinoma". Host Dr. Rafeh Naqash and Dr. Gupta discuss how FGFR3 combined with TMB emerged as a biomarker that may be predictive for response to ICPI in mUC. TRANSCRIPT Dr. Rafeh Naqash: Hello and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCO PO articles. I'm your host, Dr. Rafeh Naqash, podcast editor for JCO Precision Oncology and Associate Professor at the OU Health Stephenson Cancer Center. Today I am excited to be joined by Dr. Shilpa Gupta, Director of Genitourinary Medical Oncology at the Cancer Institute and co-leader of the GU Oncology Program at the Cleveland Clinic, and also lead author of the JCO PO article titled "Fibroblast Growth Factor Receptor 3 Alteration Status and Outcomes on Immune Checkpoint Inhibitors in Patients With Metastatic Urothelial Carcinoma." At the time of this recording, our guest's disclosures will be linked in the transcript. Shilpa, welcome again to the podcast. Thank you for joining us today. Dr. Shilpa Gupta: Thank you, Rafeh. Honor to be here with you again. Dr. Rafeh Naqash: It is nice to connect with you again after two years, approximately. I think we were in our infancy of our JCO PO podcast when we had you first time, and it has been an interesting journey since then. Dr. Shilpa Gupta: Absolutely. Dr. Rafeh Naqash: Well, excited to talk to you about this article that you published. Wanted to first understand what is the genomic landscape of urothelial cancer in general, and why should we be interested in FGFR3 alterations specifically? Dr. Shilpa Gupta: Bladder cancer or urothelial cancer is a very heterogeneous cancer. And while we find there is a lot of mutations can be there, you know, like BRCA1, 2, in HER2, in FGFR, we never really understood what is driving the cancer. Like a lot of old studies with targeted therapies did not really work. For example, we think VEGF can be upregulated, but VEGF inhibitors have not really shown definite promise so far. Now, FGFR3 receptor is the only therapeutic target so far that has an FDA approved therapy for treating metastatic urothelial cancer patients, and erdafitinib was approved in 2019 for patients whose tumors overexpressed FGFR3 mutations, alterations, or fusions. And in the landscape of bladder cancer, it is important because in patients with non-muscle invasive bladder cancer, about 70 to 80% patients can have this FGFR3. But as patients become metastatic, the alterations are seen in, you know, only about 10% of patients. So the clinical trials that got the erdafitinib approved actually used archival tumor from local cancer. So when in the real world, we don't see a lot of patients if we are trying to do metastatic lesion biopsies. And why it is important to know this is because that is the only targeted therapy available for our patients right now. Dr. Rafeh Naqash: Thank you for giving us that overview. Now, on the clinical side, there is obviously some interesting data for FGFR3 on the mutation side and the fusion side. In your clinical practice, do you tend to approach these patients differently when you have a mutation versus when you have a fusion? Dr. Shilpa Gupta: We can use the treatment regardless of that. Dr. Rafeh Naqash: I recently remember I had a patient with lung cancer, squamous lung cancer, who also had a synchronous bladder mass. And the first thought from multiple colleagues was that this is metastatic lung. And interestingly, the liquid biopsy ended up showing an FGFR3-TACC fusion, which we generally don't see in squamous lung cancers. And then eventually, I was able to convince our GU colleagues, urologists, to get a biopsy. They did a transurethral resection of this tumor, ended up being primary urothelial and synchronous lung, which again, going back to the FGFR3 story, I saw in your paper there is a mention of FGFR3-TACC fusions. Anything interesting that you find with these fusions as far as biology or tumor behavior is concerned? Dr. Shilpa Gupta: We found in our paper of all the patients that were sequenced that 20% had the pathognomonic FGFR3 alteration, and the most common were the S249C, and the FGFR3-TACC3 fusion was in 45 patients. And basically I will say that we didn't want to generate too much as to fusion or the differences in that. The key aspect of this paper was that historically there were these anecdotal reports saying that patients who have FGFR alterations or mutations, they may not respond well to checkpoint inhibitors because they have the luminal subtype. And these were backed by some preclinical data and small anecdotal reports. But since then, we have seen that, and that's why a lot of people would say that if somebody's tumor has FGFR3, don't give them immunotherapy, give them erdafitinib first, right? So then we had this Phase 3 trial called the THOR trial, which actually showed that giving erdafitinib before pembrolizumab was not better. That debunked that myth, and we are actually reiterating that because in our work we found that patients who had FGFR3 alterations or fusions, and if they also have TMB-high, they actually respond very well to single agent immunotherapy. And that is, I think, very important because it tells us that we are not really seeing that so-called potential of resistance to immunotherapy in these patients. So to answer your question, yeah, we did see those differences, but I wouldn't say that any one marker is more prominent. Dr. Rafeh Naqash: The analogy is kind of similar to what we see in lung cancer with these mutations called STK11/KEAP1, which are also present in some other tumors. And one of the questions that I don't think has been answered is when you have in lung cancer, if you extrapolate this, where doublet or single agent immunotherapy doesn't do as well in tumors that are STK11 mutated. But then if you have a high TMB, question is does that TMB supersede or trump the actual mutation? Could that be one reason why you see the TMB-high but FGFR3 altered tumors in your dataset responding or having better outcomes to immunotherapy where potentially there is just more neoantigens and that results in a more durable or perhaps better response to checkpoint therapy? Dr. Shilpa Gupta: It could be. But you know, the patients who have FGFR alterations are not that many, right? So we have already seen that just patients with TMB-high respond very well to immunotherapy. Our last podcast was actually on that, regardless of PD-L1 that was a better predictor of response to immunotherapy. So I think it's not clear if this is adding more chances of response or not, because either way they would respond. But what we didn't see, which was good, that if they had FGFR3, it's not really downplaying the fact that they have TMB-high and that patients are not responding to immunotherapy. So we saw that regardless, and that was very reassuring. Dr. Rafeh Naqash: So if tomorrow in your clinic you had an individual with an FGFR3 alteration but TMB-high, I guess one could be comfortable just going ahead with immunotherapy, which is what the THOR trial as you mentioned. Dr. Shilpa Gupta: Yes, absolutely. And you know, when you look at the toxicity profiles of pembrolizumab and erdafitinib, really patients really struggle with using the FGFR3 inhibitors. And of course, if they have to use it, we have to, and we reserve it for patients. But it's not an easy drug to tolerate. Currently the landscape is such that, you know, frontline therapy has now evolved with an ADC and immunotherapy combinations. So really if patients progress and have FGFR3 alterations, we are using erdafitinib. But let's say if there were a situation where a patient has had chemotherapy, no immunotherapy, and they have FGFR3 upregulation and TMB-high, yes, I would be comfortable with using only pembrolizumab. And that really ties well together what we saw in the THOR trial as well. Dr. Rafeh Naqash: Going to the clinical applications, you mentioned a little bit of this in the manuscript, is combination therapies. You alluded to it a second back. Everything tends to get combined with checkpoint therapy these days, as you've seen with the frontline urothelial, pembrolizumab with an ADC. What is the landscape like as far as some of these FGFR alterations are concerned? Is it reasonable to combine some of those drugs with immune checkpoint therapy? And what are some of the toxicity patterns that you've potentially seen in your experience? Dr. Shilpa Gupta: So there was indeed a trial called the NORSE trial. It was a randomized trial but not a comparative cohort, where they looked at FGFR altered patients. And when they combined erdafitinib plus cetrelimab, that did numerically the response rates were much higher than those who got just erdafitinib. So yeah, the combination is definitely doable. There is no overlapping toxicities. But unfortunately that combination has not really moved forward to a Phase 3 trial because it's so challenging to enroll patients with such kind of rare mutations on large trials, especially to do registration trials. And since then the frontline therapy has evolved to enfortumab vedotin and pembrolizumab. I know there is an early phase trial looking at a next generation FGFR inhibitor. There is a triplet combination looking in Phase 1 setting with a next generation FGFR inhibitor with EV-pembro. However, it's not a randomized trial. So you know, I worry about such kinds of combinations where we don't have a path for registration. And in the four patients that have been treated, four or five patients in the early phase as a part of basket trial, the toxicities were a lot, you know, when you combine the EV-pembro and an FGFR3 inhibitor, we see more and more toxicity. So the big question is do we really need the "kitchen sink" approach when we have a very good doublet, or unless the bar is so high with the doublet, like what are we trying to add at the expense of patient toxicity and quality of life is the big question in my mind. Dr. Rafeh Naqash: Going back to your manuscript specifically, there could be a composite biomarker. You point out like FGFR in addition to FGFR TMB ends up being predictive prognostic there. So that could potentially be used as an approach to stratify patients as far as treatment, whether it's a single agent versus combination. Maybe the TMB-low/FGFR3 mutated require a combination, but the TMB-high/FGFR mutated don't require a combination, right? Dr. Shilpa Gupta: No, that's a great point, yeah. Dr. Rafeh Naqash: But again, very interesting, intriguing concepts that you've alluded to and described in this manuscript. Now, a quick take on how things have changed in the bladder cancer space in the last two years. We did a podcast with you regarding some biomarkers as you mentioned two years back. So I really would like to spend the next minute to two to understand how have things changed in the bladder cancer space? What are some of the exciting things that were not there two years back that are in practice now? And how do you anticipate the next two years to be like? Maybe we'll have another podcast with you in another two years when the space will have changed even more. Dr. Shilpa Gupta: Certainly a lot has happened in the two years, you know. EV-pembro became the universal frontline standard, right? We have really moved away from cisplatin eligibility in metastatic setting because anybody would benefit from EV-pembro regardless of whether they are candidates for cisplatin or not, which historically was relevant. And just two days ago, we saw that EV-pembro has now been approved for localized bladder cancer for patients who are cisplatin ineligible or refusing. So, you know, this very effective regimen moving into earlier setting, we now have to really think of good treatment options in the metastatic setting, right? So I think that's where a lot of these novel combinations may come up. And what else we've seen is in a tumor agnostic trial called the DESTINY-PanTumor trial, patients who had HER2 3+ on immunohistochemistry, we saw the drug approval for T-DXd, and I think that has kind of reinvigorated the interest in HER2 in bladder cancer, because in the past targeting HER2 really didn't work. And we still don't know if HER2 is a driver or not. And at ESMO this year, we saw an excellent study coming out of China with DV which is targeting HER2, and toripalimab, which is a Chinese checkpoint inhibitor, showing pretty much similar results to what we saw with EV-pembro. Now, you know, not to do cross-trial comparisons, but that was really an amazing, amazing study. It was in the presidential session. And I think the big question is: does that really tell us that HER2-low patients will not benefit? Because that included 1+, 2+, 3+. So that part we really don't know, and I think we want to study from the EV-302 how the HER2 positive patients did with EV and pembro. So that's an additional option, at least in China, and hopefully if it gets approved here, there is a trial going on with DV and pembro. And lastly, we've seen a very promising biomarker, like ctDNA, for the first time in bladder cancer in the adjuvant setting guiding treatment with adjuvant atezolizumab. So patients who were ctDNA positive derived overall survival and recurrence-free survival benefit. So that could help us select moving forward with more studies. We can spare unnecessary checkpoint inhibitors in patients who are not going to benefit. So I think there is a lot happening in our field, and this will help do more studies because we already have the next generation FGFR inhibitors which don't have the toxicities that erdafitinib comes with. And combining those with these novel ADCs and checkpoint inhibitors, you know, using maybe TMB as a biomarker, because we really need to move away from PD-L1 in bladder cancer. It's shown no utility whatsoever, but TMB has. Dr. Rafeh Naqash: Well, thank you so much, Shilpa, for that tour de force of how things have changed in bladder cancer. There used to be a time when lung and melanoma used to lead this space in terms of the number of approvals, the biomarker development. It looks like bladder cancer is shifting the trend at this stage. So definitely exciting to see all the new changes that are coming up. I'd like to spend another minute and a half on your career. You've obviously been a leader and example for many people in the GU space and beyond. Could you, for the sake of our early career especially, the trainees and other listeners, describe how you focused on things that you're currently leading as a leader, and how you shaped your career trajectory over the last 10 years? Dr. Shilpa Gupta: That's a really important question, Rafeh, and you and I have had these discussions before, you know, being an IMG on visas like you, and being in different places. I think I try to make the most of it, you know, instead of focusing on the setbacks or the negative things. Like tried to grab the opportunities that came along. When I was at Moffitt, got to get involved with the Phase 1 trial of pembrolizumab in different tumor types. And just keeping my options open, you know, getting into the bladder cancer at that time when I wanted to really do only prostate, but it was a good idea for me to keep my options open and got all these opportunities that I made use of. I think an important thing is to, like you said, you know, have a focus. So I am trying to focus more on biomarkers that, you know, we know that 70% patients will respond to EV-pembro, right? But what about the remaining 30%? Like, so I'm really trying to understand what determines hyperprogressors with such effective regimens who we really struggle with in the clinic. They really don't do well with anything we give them after that. So we are doing some work with that and also trying to focus on PROs and kind of patient-reported outcomes. And a special interest that I've now developed and working on it is young-onset bladder cancer. You know, the colorectal cancer world has made a lot of progress and we are really far behind. And bladder cancer has historically been a disease of the elderly, which is not the case anymore. We are seeing patients in their 30s and 40s. So we launched this young-onset bladder cancer initiative at a Bladder Cancer Advocacy Network meeting and now looking at more deep dive and creating a working group around that. But yeah, you know, I would say that my philosophy has been to just take the best out of the situation I'm in, no matter where I am. And it has just helped shape my career where I am, despite everything. Dr. Rafeh Naqash: Well, thank you again. It is always a pleasure to learn from your experiences and things that you have helped lead. Appreciate all your insights, and thank you for publishing with JCO PO. Hopefully we will see more of your biomarker work being published and perhaps bring you for another podcast in a couple of years. Dr. Shilpa Gupta: Yeah, thank you, Rafeh, for the opportunity. And thanks to JCO PO for making these podcasts for our readers. So thanks a lot. Dr. Rafeh Naqash: Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcast. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. DISCLOSURES Dr. Shilpa Gupta Stock and Other Ownership Interests: Company: BioNTech SE,  Nektar Consulting or Advisory Role: Company: Gilead Sciences, Pfizer, Merck, Foundation Medicine, Bristol-Myers Squibb/Medarex, Natera, Astellas Pharma, AstraZeneca, Novartis, Johnson & Johnson/Janssen Research Funding: Recipient: Your Institution Company: Bristol Myers Squibb Foundation, Merck, Roche/Genentech, EMD Serono, Exelixis, Novartis, Tyra Biosciences, Pfizer, Convergent Therapeutics, Acrivon Therapeutics, Flare Therapeutics, Amgen Travel, Accommodations, Expenses: Company: Pfizer, Astellas Pharma, Merck    

In this first episode of Beyond the Rounds, host Dr. Nolan Fisher sits down with internationally recognized neurosurgeon Dr. Dilan Ellegala to break down some of the most common conditions in cranial neurosurgery. Together, they walk through real clinical cases and discuss what every clinician should know about indications, imaging, surgical decision-making and how to avoid low-value neurosurgical care.Dr. Ellegala shares insights from his extensive training (University of Washington, University of Virginia, Brigham & Women's/Harvard) and global health work, offering a grounded, practical lens for both primary care providers and specialists.What we cover in this episode:Meningioma evaluation & management– How vague headaches present– When to image– What MRI findings matter– Treatment pathways and realistic surgical outcomesPituitary tumors– Visual changes, hormonal symptoms & incidental findings– When surgery is indicated– Expected results from modern techniquesAneurysm case (subarachnoid hemorrhage)– Differentiating dangerous headaches from migraine– How CTA findings drive intervention– Red flags not to missTrigeminal neuralgia– Classic symptom patterns– Vascular compression on imaging– Medical vs. surgical managementMyth vs. MedicineDr. Ellegala addresses common patient fears — “brain tumors are always fatal,” “my head will be shaved,” “minimally invasive options don't exist” — and reframes them with facts, outcomes data and modern neurosurgical approaches.Systems & ReferralsWe also break down:• What multidisciplinary neurosurgical care actually looks like• How coordinated pathways improve outcomes• What makes a high-quality referral (and where patients fall through the cracks)About Our Guest:Dilan Ellegala, MD, is a neurosurgeon specializing in cerebrovascular, skull base and microneurosurgery, with more than 50 publications and international work advancing global neurosurgical care.

Many founders wait for the “perfect moment” to sell or fixate on hitting a specific valuation target, but both can lead to missed opportunities. In this episode, Sarah Letourneau from Goldman Sachs joins Mike Lyon to discuss the most common mistakes they see founders make on the path to an exit; from waiting too long to run a process, to anchoring on a headline number, to assembling the wrong deal team. They share how to plan ahead, build the right advisors around you, and make informed decisions that support both your transaction and your life after the deal.Securities offered through Vista Point Advisors, member FINRA/SIPC. This has been provided for informational purposes only and should not be considered as investment advice or a recommendation. It is not intended to address all circumstances that might arise. The views expressed herein may change at any time subsequent to the date of issue. Opinions contained herein should not be interpreted as a guarantee of future results. Outcomes will vary depending on individual circumstances. Any examples used in this material are generic, hypothetical and for illustration purposes only. Testimonials from past clients may not be representative of the experience of other clients and there is no guarantee of future performance or success. Clients are not compensated for their comments.

The FiltrateJoel Topf‍ ‍@kidneyboy.bsky.social‬ (COI)Swapnil Hiremath @hswapnil.medsky.social and on LinkedInPedro Teixeira @nephcrit.bsky.socialSpecial Guests Charmaine E Lok, MD Professor of Medicine at the Faculty of Medicine, University of TorontoEditing and Show Notes byJoel TopfThe Kidney Connection written and performed by Tim YauShow NotesFish-Oil Supplementation and Cardiovascular Events in Patients Receiving Hemodialysis NEJM | NephJCWhat works in hemodialysis?Iron: PIVOTAL Trial (NEJM)Hemodiafiltration: CONVINCE (NEJM)That's the whole listEarlier work on vascular access, The FISH Trial: Effect of fish oil supplementation on graft patency and cardiovascular events among patients with new synthetic arteriovenous hemodialysis grafts: a randomized controlled trial JAMAEskimo myth: "Fishing" for the origins of the "Eskimos and heart disease" story: facts or wishful thinking? (PubMed)Dialysis patients have low levels of fish oil in their body (PubMedCentral)Positive trial in non-dialysis patients: REDUCE-ITNegative trial of fish oil in non-dialysis patients: STRENGTHACC does not recommend FISH Oil for primary or secondary prevention of CV events (ACC)Poisson distribution (Wikipedia)Ocean Nutrition Canada (Wikipedia)Ocean Nutrition was bought by DSM (Press Release)DSM merged with Firmenich (Press Release)Vanguard feasibility trials (PubMed)Freezing fish oil caps will eliminate the fishy aftertaste (Pharmacists Letter)The study also received a philanthropic donation from Mr. Alexander Epstein (UHN Research)Selection Bias, Interventions and Outcomes for Survivors of Cardiac Arrest (PubMedCentral)Effectiveness of fish oil in controlling inflammation in adult patients undergoing hemodialysis: A systematic review and meta-analysis (PubMed)Tubular SecretionsSwapnil Hiremath: Michael Clayton (IMDB)Pedro: Fifa World Cup Soccer coming to North America with Portugal! (FIFA)Charmaine: New Puppy, Rose. It's a Barbet (Wikipedia)Joel Topf: The Dark Forrest by Liu Cixin (Wikipedia)

AI investments? Everywhere. AI training? .......

Ever feel like decisions in your nonprofit take forever… or worse, no one knows who's actually supposed to make them? In this episode, I break down why unclear decision-making slows your organization to a crawl, how to fix confusion between staff and the board, and the simple tools that help teams move faster without chaos. If delays are costing you time, money, and client well-being, this one will bring some welcome clarity. Episode Highlights 00:00 Introduction and Funny Story 01:51 Today's Topic: Decision Making in Organizations 04:43 Clarifying Board Decision Making 07:53 Guiding Principles for Decision Making 11:23 Functions and Outcomes in Nonprofits 13:16 Heads and Hands Roles in Teams 16:30 Conclusion and Further Resources Resource The Board Clarity Club A monthly membership for boards that provides training and live expert support to help your board have total clarity on how to be the best board possible. Learn More >> About Your Host Have you seen Casino Royale? That moment when Vespa slides in elegantly, opposite James, all charming smile, razor-sharp wit and mighty brainpower, and says, "I'm the money"? Well, your host, Sarah Olivieri has been likened to Vespa by one of her clients – not just because she's charming, beautiful and brainy– but because that bold statement "I'm the money" was, as it turned out, right ON the money. Sarah helps nonprofits transform their organizations from failing to thriving. And she's very, very good at it. She's brought nonprofits back from the brink of insolvency. She's averted major cash-flow crises, solved funding droughts, board conflicts and everything in between… and so she has literally become "the money" for many of the organizations she works with. As the former director of 3 nonprofits and founder of 5 for-profit businesses, she understands, deeply, the challenges and complexities facing organizations and she's created a framework, called The Impact Method®️, which can help you simplify operations, build aligned teams and make a bigger impact without getting overwhelmed or burning out – and Every. Single. One. Of her clients that have implemented her methodologies have achieved the most incredible results. Sarah is also a #1 international bestselling author, holds a BA from the University of Chicago with a focus on globalization and its effect on marginalized cultures, and a master's degree in Humanistic and Multicultural Education from SUNY New Paltz. Access additional training at www.pivotground.com/funding-secrets or apply for the THRiVE Program for personalized support at www.pivotground.com/application Be sure to subscribe to Inspired Nonprofit Leadership so that you don't miss a single episode, and while you're at it, won't you take a moment to write a short review and rate our show? It would be greatly appreciated! Let us know the topics or questions you would like to hear about in a future episode. You can do that and follow us on LinkedIn.

GDP Script/ Top Stories for December 11th Publish Date: December 11th PRE-ROLL: SUGAR HILL ICE SKATING From the BG AD Group Studio Welcome to the Gwinnett Daily Post Podcast. Today is Thursday, December 11th and Happy birthday to Nikki Six I’m Peyton Spurlock and here are your top stories presented by KIA Mall of Georgia. Atlanta Christkindl Market proving a hit in Lawrenceville Gwinnett commissioners OK 4% salary adjustment for county employees Paul Duke STEM High School honored for work to improve student outcomes Plus Shane Delancey the Director of the Christmas Tradition at the Strand Theatre All of this and more is coming up on the Gwinnett Daily Post podcast, and if you are looking for community news, we encourage you to listen daily and subscribe! Break 1: GCPS Hiring-Villa Rica Wonderland Train STORY 1: Atlanta Christkindl Market proving a hit in Lawrenceville Avery Boutin and Jordan Lettis had never been to the Atlanta Christkindl Market before, but now that it’s landed in their backyard? They couldn’t resist. Sunday night, they joined the crowd under twinkling string lights, wandering the aisles, riding the Ferris wheel, and—of course—grabbing raclette sandwiches. This is the market’s first year in Lawrenceville, and it’s already a hit. City Manager Chuck Warbington said it’s tripled downtown foot traffic. Vendors? 90 booths, everything from bratwursts to alpaca scarves. And the hot chocolate line? Let’s just say, patience required. STORY 2: Gwinnett commissioners OK 4% salary adjustment for county employees Gwinnett County employees just got an early Christmas surprise—4% raises, approved by commissioners on Tuesday. Starting pay? Now at least $40,000 a year for full-timers. Not bad, right? The adjustment, retroactive to Oct. 25, bumps up pay ranges across the board, including public safety roles. Chairwoman Nicole Love Hendrickson called it a step toward addressing inflation and keeping Gwinnett competitive. “We’re investing in the people who keep this county running,” she said. With a $2.6 billion budget vote looming in January, it’s unclear how this raise fits in. But for now? A little extra in the paycheck feels good. STORY 3: Paul Duke STEM High School honored for work to improve student outcomes Paul Duke STEM High just snagged a huge honor—one of only two schools in Georgia named a 2025 National ESEA Distinguished School. Pretty big deal, right? This recognition isn’t handed out lightly. It’s for Title I schools that are crushing it academically and making real strides with their students. Principal Dr. Jonathon Wetherington couldn’t be prouder. “This is about our students, our teachers, our families—all of us,” he said. Their STEMforALL initiative? Game-changer. It’s hands-on, rigorous, and inclusive, reaching multilingual learners, students with disabilities, and those facing economic challenges. Oh, and Flex Fridays? Genius. Targeted support, projects, college prep—it’s working. Graduation rates? Over 90%. We have opportunities for sponsors to get great engagement on these shows. Call 770.874.3200 for more info. We’ll be right back Break 2: Kia Mall of Georgia - DTL HOLIDAY STORY 4: Gwinnett County Public Library offering RISE Teen Entrepreneurship program Got a teen with big dreams of running their own business? Gwinnett County Public Library’s RISE Teen Entrepreneurship Program might be just the thing. Starting Feb. 17, 2026, this four-week crash course will teach teens (ages 13–19) how to turn ideas into real businesses. Here’s the deal: they’ll brainstorm, build a business plan, and pitch their ideas to local entrepreneurs in a Shark Tank-style showdown. Winners? Cash prizes. Meetings are weekly, 5:30–7:30 p.m., at the Lawrenceville Hooper-Renwick branch. Deadline to apply? Jan. 5. Oh, and library cardholders can use maker spaces—think laser printers, podcast gear, sewing machines—for free. Dream big, Gwinnett! STORY 5: Touchdown Club of Gwinnett Honors Best in 2025 High School Football The Touchdown Club of Gwinnett threw a big bash Monday at 12Stone Church, celebrating the absolute best of Gwinnett high school football from the 2025 season. And wow, what a lineup. Buford’s Tyriq Green snagged Athlete of the Year—no surprise there, considering he’s leading his team to the Class AAAAAA state finals. North Gwinnett cleaned up too, with Zach Lewis (Offensive Lineman), Max Patterson (Tight End), and Chauncey Davis (Defensive Back) all taking home top honors. Other schools? Brookwood, Collins Hill, and Grayson had multiple winners, too. Honestly, the talent in this county is unreal. Full list? It’s long—like, really long. But trust me, these kids earned it. GEORGIA SWARM: The Georgia Swarm are itching to get back on the floor. After dropping their season opener to Buffalo—yeah, the three-time champs, no big deal—they’ve had a week off to regroup. That 15-11 loss? Not ideal. Saturday, Dec. 13, they’re finally at home, Gas South Arena, facing the Oshawa FireWolves. Rookie Nolan Byrne? Scored his first goal in Buffalo. Shayne Jackson? Four goals, still a beast. And this team? Big. Fast. Aggressive. Fans better buckle up—it’s gonna be fun. Here is Shane Delancey the Director of the Christmas Tradition at the Strand Theatre Break 3: THE STRAND - Ingles Markets 7 - THE SUGAR HILL HOLIDAY Signoff – Thanks again for hanging out with us on today’s Gwinnett Daily Post Podcast. If you enjoy these shows, we encourage you to check out our other offerings, like the Cherokee Tribune Ledger Podcast, the Marietta Daily Journal, or the Community Podcast for Rockdale Newton and Morgan Counties. Read more about all our stories and get other great content at www.gwinnettdailypost.com Did you know over 50% of Americans listen to podcasts weekly? Giving you important news about our community and telling great stories are what we do. Make sure you join us for our next episode and be sure to share this podcast on social media with your friends and family. Add us to your Alexa Flash Briefing or your Google Home Briefing and be sure to like, follow, and subscribe wherever you get your podcasts. Produced by the BG Podcast Network Show Sponsors: www.ingles-markets.com www.kiamallofga.com Ice Rink – Downtown Sugar Hill Holiday Celebration 2025 – City of Sugar Hill https://www.downtownlawrencevillega.com/ Team GCPS News Podcast, Current Events, Top Headlines, Breaking News, Podcast News, Trending, Local News, Daily, News, Podcast, Interviews See omnystudio.com/listener for privacy information.

In Part 2 of our interview with Dusty Gulleson, CEO of eResources, we explore how value-driven project discovery helps teams make better decisions, prevent waste, and build software that actually supports the business. Dusty goes deep into prioritization, budgeting, revenue-generating processes, and why discovery is essential for steering both startups and large enterprises toward meaningful outcomes. About Dusty Gulleson Dusty Gulleson is a founder who never set out to build a large company—he simply followed the work, served people well, and let loyalty drive the growth. After leaving a COO role that didn't fit, he waited tables, picked up freelance web projects, and gradually built what is now eResources, a 100+ person organization spanning strategy, branding, IT services, cybersecurity, SaaS automation, and offshore teams. Born in Indonesia and now leading four thriving divisions, Dusty has grown the company without hype or outside funding, relying instead on relationships, trust, and consistent delivery. With five acquisitions under his belt and recurring revenue across industries like housing, higher education, and public health, his leadership philosophy centers on people, clarity, and service. Whether in a boardroom or a bourbon tasting room, Dusty approaches every conversation with the same question: "Where do you want to go, and how can we help?" Why Value-Driven Project Discovery Matters Many organizations want to move fast, but not necessarily in the right direction. Dusty explains that teams often fixate on long feature lists instead of business value. Value-driven project discovery flips that conversation by asking: What outcome are you trying to achieve? This shift helps clients focus on what matters most instead of chasing nice-to-have ideas. "Everyone's looking at the finish line, but no one is asking what the starting line really looks like." Using Value-Driven Project Discovery to Find True Priorities Dusty combines the 80/20 rule with the MoSCoW method to identify what the project truly needs at launch. Clients frequently bring big ideas, but through value-driven project discovery, his team uncovers the 20% that delivers 80% of the impact. The Must-Haves rise to the top naturally when tied back to real outcomes. Cutting Through Data Bloat One recurring obstacle is data collection bloat—requests to capture everything "just in case." Dusty highlights how the value-driven approach clears away unnecessary data points so teams can focus on action-driving information. This reduces complexity, speeds delivery, and saves money. Budget Reality Checks Dusty emphasizes that constraints are real and useful. Budgets shape scope, timelines, and phases. Instead of forcing everything into a fixed number, focusing on value helps teams see what is truly feasible. Often, clients don't understand how misaligned their vision and budget are until the story is mapped out clearly. Identifying Golden Processes Using Value-Driven Project Discovery Golden processes—the steps that generate revenue or sustain the business—are central to prioritization. During value-driven project discovery, Dusty helps clients identify the processes that keep the company moving. Once those are defined, secondary ideas naturally fall into later phases. "Your golden processes determine where the first dollars must go." Value-Driven Project Discovery and the Chapter-One Mindset Big visions don't require big bang releases. Dusty encourages a chapter-one approach: start small, deliver one valuable win, and build momentum. A $100 improvement today may pave the way for a $1,000 investment tomorrow. This phased approach reduces risk and increases adoption. Applying Value-Driven Project Discovery to Grow Without VC Funding Dusty's entrepreneurial journey is a testimony to value-driven thinking. He grew his company to 100+ employees without venture capital—using time, grit, SBA vehicles, and strategically acquired businesses. Value-driven helps guide decisions about where to invest and when to scale. Overcoming Crisis Through Value-Driven Project Discovery During the 2008 financial crisis, Dusty leaned heavily on value-first thinking. Cash froze, clients paused payments, and vendors struggled. Instead of panicking, he relied on relationships, transparency, and careful evaluation of what mattered most. Value-driven project discovery helped him make decisions grounded in clarity rather than fear. How Value-Driven Project Discovery Builds Better Relationships At its core, discovery is a relationship-building exercise. Clients don't just need developers—they need partners who understand their story, their challenges, and their business realities. Dusty reminds us that consulting is as much about people and process as it is about technology. Lessons for Founders Dusty closes with important advice for new founders: learn to talk to people, listen with empathy, and understand their story. Tools and platforms matter, but only after you fully grasp the problem. "People want to be heard. When they're heard, you can actually solve their problem." Stay Connected: Join the Developreneur Community We invite you to join our community and share your coding journey with us. Whether you're a seasoned developer or just starting, there's always room to learn and grow together. Contact us at info@develpreneur.com with your questions, feedback, or suggestions for future episodes. Together, let's continue exploring the exciting world of software development. Additional Resources Software Architecture Deliverables – Provide The Story Software Development Requirements: Staying True to Specifications Why Setting Deadlines Is the Key to Successful Projects Building Better Foundations Podcast Videos – With Bonus Content

Howie and Harlan are joined by Basmah Safdar, a Yale School of Medicine emergency physician and an expert on sex-specific differences in cardiovascular and microvascular health, which have important implications for the understanding and treatment of heart attacks, long COVID, and other conditions. Harlan reports on Australia's ban on social media for kids, and a Medicare pilot program that will pay providers based on improved outcomes in chronic conditions. Howie unpacks the consequences of the CDC's change to its recommendations for newborn hepatitis B vaccination. Show notes: Social Media and Kids "Australia's Social Media Ban for Children Takes Effect" Health & Veritas Episode 197: Peter Hotez: Mapping the Anti-Science Machine Medicare's ACCESS Payment Model CMS: ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model Basmah Safdar "Medical School Enrollment Reaches 100,000 Students for the First Time" Health & Veritas: Episode 176: Live at the Yale Innovation Summit 2025 "Myocardial ischemia in women: lessons from the NHLBI WISE study" "Sex Differences in COVID-19 Immune Responses Affect Patient Outcomes" "Scientists unravel mystery of sex disparities in COVID-19 outcomes" Health & Veritas Episode 192: Akiko Iwasaki: What Have We Learned About Long COVID? "Basmah Safdar, MD, FACEP, Appointed Director, Women's Health Research at Yale (WHRY)" Women's Health Research at Yale "Women's Health Research at Yale: The Prologue" "History of Women's Participation in Clinical Research" "Policy: NIH to balance sex in cell and animal studies" "Heart attack symptoms often misinterpreted in younger women" Harlan Krumholz: "Sex Difference in Outcomes of Acute Myocardial Infarction in Young Patients" "Women's Health: More Than 'Bikini Medicine'" "Celebrating Carolyn Mazure" "Women's Health Research at Yale: Our Research"  "Current Status of Gender and Racial/Ethnic Disparities Among Academic Emergency Medicine Physicians" "New Women's Health Fund of Funds Launches to Activate $60B in Life Sciences Capital" "Closing the women's health gap: A $1 trillion opportunity to improve lives and economies" "Blueprint to close the women's health gap: How to improve lives and economies for all" "Gates Foundation pledges $2.5 billion to women's health initiatives" "Milken Institute Launches New Women's Health Network, Former First Lady Jill Biden Joins as its Chair" Women's Health Research at Yale: Pilot Project Program Funding Note: Deadline is December 22. Women's Health Research at Yale: Collaborative CDC and Hepatitis B "Panel Votes to Stop Recommending Hepatitis B Shots at Birth for Most Newborns" CDC: Hepatitis B Vaccine Safety WHO: Hepatitis B "New review finds no evidence to support delaying universal hepatitis B birth-dose vaccination" In the Yale School of Management's MBA for Executives program, you'll get a full MBA education in 22 months while applying new skills to your organization in real time. Yale's Executive Master of Public Health offers a rigorous public health education for working professionals, with the flexibility of evening online classes alongside three on-campus trainings. Email Howie and Harlan comments or questions.

SportsBrokers.com CEO Kevin Todd wants you to help turn betting into a business - he's got a free play for Eagles-Raiders today and wants you to get more

Join Dr Sofia Ramiro and Professor Xenofon Baraliakos as they discuss the top publications in the world of axSpA. This month, the conversation covered a retrospective, multinational, cross-sectional survey of real-world outcomes for patients with axial spondyloarthritis receiving subcutaneous infliximab

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Dr. Laurens Ceulemans, thoracic surgeon at the University Hospitals Leuven in Belgium, about lung volume reduction. Chapters 00:00 Intro 02:41 Right to Repair, Robotics Re-Use 04:53 REPEAT Trial 06:30 JANS 1, PCI After CABG Randomized Trial 08:01 JANS 2, No-Touch vs Conventional Saph Veins 11:04 JANS 3, Sir Terence English & Keyvyn Mohagissi 12:09 CTSNet Recruitment Guide 12:54 Video 1, JCOG0802 Bombshell & Webinar 16:33 Video 2, Endoscopic Cardiac Foreign Body Extraction 17:56 Video 3, First Europe Robotic AVR Perceval Valve 18:42 Video 4, Bilateral VATS Sympathectomy 20:10 Laurens Ceulemans Interview 34:15 Upcoming Events 34:48 Closing They highlighted key takeaways from the procedure and addressed the issue of air leaks. They also discussed bilateral lung volume reduction and emphasized the importance of a team approach. Additionally, they focused on why surgeons should be selecting the healthiest patients for this operation rather than the most critically ill, as well as the future of lung volume reduction.    Joel also highlights recent JANS articles on a multicenter, randomized trial on the PCI of native coronary artery vs saphenous vein graft after prior bypass surgery, a meta-analysis of randomized trials on the outcomes of no-touch vs conventionally harvested saphenous veins for coronary artery bypass surgery, and the death of transplant pioneer Sir Terence English at 93.  In addition, Joel explores bombshell 10-year JCOG0802 results showing lobectomy is superior to segmentectomy for lung cancer, endoscopic extraction of a cardiac foreign body, the first robotic aortic valve replacement in Europe using a Perceval valve, and bilateral VATS sympathectomy for ventricular tachycardia electrical storm. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) PCI of Native Coronary Artery vs Saphenous Vein Graft After Prior Bypass Surgery: A Multicenter, Randomized Trial  2.) Outcomes of No-Touch Vs Conventionally Harvested Saphenous Veins for Coronary Artery Bypass Surgery: A Meta-Analysis of Randomized Trials  3.) Transplant Pioneer Sir Terence English Dies at 93  CTSNet Content Mentioned  1.) Bombshell 10-Year JCOG0802 Results Show Lobectomy Is Superior to Segmentectomy for Lung Cancer  2.) Military Heart Trauma: Endoscopic Extraction of a Cardiac Foreign Body  3.) First Robotic Aortic Valve Replacement in Europe Using a Perceval Valve   4.) Bilateral VATS Sympathectomy for Ventricular Tachycardia Electrical Storm  Other Items Mentioned  1.) Restore Robotics   2.) 2025 Endoscopic Cardiac Surgeons Club Video Competition  3.) 2025 CTSNet Recruitment Guide   4.) Career Center   5.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

Would you like access to our advanced agency training for FREE? https://www.agencymastery360.com/training Why do clients keep asking for deliverables they don't actually need? How to get them to focus on the outcome instead of the task list? Every agency owner has had clients show up asking for a website, SEO, or a million social posts, when what they actually need is something much deeper: more leads, more profit, more time back, and a business they're proud of again. Today's featured guest broke down how he built an 11-year-old shop that delivers exactly that. We dig into why small businesses really hire agencies, why "selling SEO" is a trap, and how simplifying complex work can make your agency more profitable, more trusted, and a hell of a lot easier to run. Nico Biggi, Founder of The Gorilla Agency a full-service Oregon digital agency that helps small businesses achieve their marketing goals. After applying to 31 agencies and hearing absolutely nothing back, he decided if no one would hire him, he'd simply build the place he wished existed. Eleven years later, his agency helps small businesses fall in love with their companies again by delivering marketing that feels personal, purposeful, and rooted in truth—not hype. In this interview, we'll discuss: Why clients don't want SEO and what small business are really buying. How radical simplicity makes agencies more profitable. Walking away from big clients to make your agency stronger. How AI is changing client expectations. Subscribe Apple | Spotify | iHeart Radio Sponsors and Resources E2M Solutions: Today's episode of the Smart Agency Masterclass is sponsored by E2M Solutions, a web design, and development agency that has provided white-label services for the past 10 years to agencies all over the world. Check out e2msolutions.com/smartagency and get 10% off for the first three months of service. Why Clients Don't Actually Want SEO (And What They're Really Buying from Agencies) Nico knows why his clients first reach out and he understands that, in reality, no one wants SEO. No one wants a website. No one wants a content calendar. What they want is for their phone to ring. They want predictable revenue and to stop feeling behind. Basically, they want a business that finally looks and performs the way they imagined when they started it. Hence, when Nico sits with a new client, he doesn't take their request at face value. He keeps pulling the thread: Why do you want that? What are you really trying to fix? What's happening behind the scenes that made you reach out today? By the time he gets to the core problem, the tactical service almost never matches the thing they originally asked for. And that's where trust is built—showing clients the real path to their desired outcome, not the task list they think they need. As he puts it: Services are the toolkit. Outcomes are the reason you pick up the tools. How Radical Simplicity Makes Agencies More Profitable and Improves Client Trust During client meetings, Nico strives to strip away the complexity agencies tend to hide behind. Clients don't want a masterclass in keyword density or a dissertation-length PDF they'll never read. They want clarity. To him, the best operators and the best salespeople think like teachers. Teachers take complicated ideas and make them accessible. They speak in a way a fifth grader can understand, because simplicity builds confidence, and confidence builds buy-in. Inside his own agency, this shows up in the way he trains his team. No silos. No "not my job." Everyone learns how every part of the system works, from content, SEO, design, dev, and strategy. That shared understanding creates respect, efficiency, and a culture where no one feels like they're building in the dark. Everyone in his team is taught that no one is above anyone and they're all running the machine together. It's a mindset that creates accountability among the team and helps the client understand exactly what they're paying for. Why Saying No to Big Clients Can Make Your Agency Stronger Every agency owner has a moment where the "big" client forces them to rethink everything. For Nico, it was early on, when a client offered him more money than he even asked for ($10k a month) and three months later, he fired the client. On paper, it was a dream account. In practice, it drained the team, misaligned with their process, and became the catalyst for rebuilding the agency from the ground up. He spent two years refining every process—on-page and off-page SEO, content creation, design systems, communication workflows—all centered around one thing: making sure clients always know where their money is going and how it's working. Most agencies duct-tape their operations when things get messy instead of rebuilding the underlying, broken system. Nico rebuilt his foundation truly believing that all business owners need is for someone to create systems, truly listen to them, and help them articulate what they do for their clients. Authenticity Converts (And Your Clients Need Your Help to Show It) Nico's wife unknowingly became the perfect case study for modern buyer behavior. Before choosing anything (restaurants, local services, events) she checks: Reviews Menus FAQs Photos Location Details User experience Credibility That's what most customers are doing, and the standard Nico sets for his clients. He wants to work with businesses that engage with clients and answer their questions, show their work with real photos, tell compelling stories, show proof, have a clean, intuitive website. If it doesn't pass what Nico calls "the wife test" — if a business doesn't have clear answers, real photos, social proof, strong UX, and transparent information — it doesn't ship. And the same goes for exclusivity: Nico refuses to work with two companies in the same industry and service area. He wants to make one the best, not compete against himself for small wins. How AI Is Changing Client Expectations and Why It Won't Replace Agencies Nico sees AI from both angles: the opportunity and the threat. On one hand, AI makes clients think everything should be instant and $500. He's already had clients send him AI-generated instructions like they're firing off tasks to a robot. The danger isn't AI itself but rather clients misunderstanding what real strategy, design, content, and user experience actually require. But the other side is where he sees massive upside. AI removes the repetitive, thankless tasks that bog agencies down. It gives teams more room to think, solve, and create. It lets agencies deliver more value, not less, if they use it correctly. AI doesn't replace strategy and, more importantly, it doesn't replace the human connection that actually closes deals. Your network is your edge. Tools evolve but human trust, real expertise, and the ability to guide clients through complexity—that doesn't. Do You Want to Transform Your Agency from a Liability to an Asset? Looking to dig deeper into your agency's potential? Check out our Agency Blueprint. Designed for agency owners like you, our Agency Blueprint helps you uncover growth opportunities, tackle obstacles, and craft a customized blueprint for your agency's success.

Dr. Fei-Fei Li (@drfeifei) is the inaugural Sequoia Professor in the Computer Science Department at Stanford University, a founding co-director of Stanford's Human-Centered AI Institute, and the co-founder and CEO of World Labs, a generative AI company focusing on Spatial Intelligence. She is the author of The Worlds I See: Curiosity, Exploration, and Discovery at the Dawn of AI, her memoir and one of Barack Obama's recommended books on AI and a Financial Times best book of 2023.This episode is brought to you by:Seed's DS-01® Daily Synbiotic broad spectrum 24-strain probiotic + prebiotic: https://seed.com/timHelix Sleep premium mattresses: https://helixsleep.com/timCoyote the card game​, which I co-created with Exploding Kittens: https://coyotegame.com/Wealthfront high-yield cash account: https://wealthfront.com/timNew clients get 3.50% base APY from program banks + additional 0.65% boost for 3 months on your uninvested cash (max $150k balance). Terms apply. The Cash Account offered by Wealthfront Brokerage LLC (“WFB”) member FINRA/SIPC, not a bank. The base APY as of 11/07/2025 is representative, can change, and requires no minimum. Tim Ferriss, a non-client, receives compensation from WFB for advertising and holds a non-controlling equity interest in the corporate parent of WFB. Experiences will vary. Outcomes not guaranteed. Instant withdrawals may be limited by your receiving firm and other factors. Investment advisory services provided by Wealthfront Advisers LLC, an SEC-registered investment adviser. Securities investments: not bank deposits, bank-guaranteed or FDIC-insured, and may lose value.*For show notes and past guests on The Tim Ferriss Show, please visit tim.blog/podcast.For deals from sponsors of The Tim Ferriss Show, please visit tim.blog/podcast-sponsorsSign up for Tim's email newsletter (5-Bullet Friday) at tim.blog/friday.For transcripts of episodes, go to tim.blog/transcripts.Discover Tim's books: tim.blog/books.Follow Tim:Twitter: twitter.com/tferriss Instagram: instagram.com/timferrissYouTube: youtube.com/timferrissFacebook: facebook.com/timferriss LinkedIn: linkedin.com/in/timferrissSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Ken Carman and Anthony Lima explain why wins are still a priority alongside Shedeur Sanders' growth as an NFL quarterback.

For years now, scientists have shown that daily exposure to bright light therapy, which simulates the intensity of outdoor light, can be beneficial for people with insomnia and other sleep disorders, Seasonal Affective Disorder or other forms of depression. But what if bright light therapy can help people recover from concussions or other traumatic brain injuries? And what if it can also lower the risk of neurodegenerative diseases like Parkinson’s or Alzheimer’s, which people with TBIs are at higher risk for?    Scientists at Oregon Health & Science University were recently awarded a $4 million grant from the U.S. Department of Defense to explore these questions and possibly unlock more secrets about sleep and its effect on health. The OHSU researchers will recruit nearly 120 military veterans who have suffered a TBI. The participants will be given a light box to use at home for one hour each morning for four weeks. Blood samples will be drawn from participants to look for changes in markers that signal inflammation in the brain and changes in oxygen uptake in brain cells.    MRI scans of participants’ brains will also help reveal if the bright light therapy has improved activity of the glymphatic system - a relatively recent discovery about the role of sleep in reducing toxins that can lead to neurodegenerative diseases like Alzheimer’s. Joining us for more details of the study and to share new insights about sleep science is Jonathan Elliott, assistant professor of neurology and co-director of the Sleep & Health Applied Research Program at OHSU.

Send us a textThis episode features Nick Brunacini, Terry Garrison, and John Vance.We push past acronyms and politics to center customer service as the fire service's true north, linking training, staffing, and culture to outcomes for Mrs. Smith. We call out FINO departments, hazing, weak command presence, and political gamesmanship that erode trust and increase risk.• customer service as the organizing principle for chiefs and unions• training tied to standard problem-solving outcomes• tactics anchored to life safety through fire control• FINO departments and response time realities• overtime, constant staffing, and budget politics• using mayday and fatality data to defend night staffing• on-scene education to convert angry customers to allies• hazing, misconduct, and decisive leadership in crises• NIOSH lessons, lawsuits, and predictable, preventable failures• inside–outside culture alignment and whistleblower safety• influence over control as a leadership stance Make sure to subscribe and tell your friends.This episode was recorded at the Alan V. Brunacini Command Training Center in Phoenix on December 4, 2025.For Waldorf University Blue Card credit and discounts: https://www.waldorf.edu/blue-card/For free command and leadership support, check out bshifter.comSign up for the B Shifter Buckslip, our free weekly newsletter here: https://lp.constantcontactpages.com/su/fmgs92N/BuckslipShop B Shifter here: https://bshifter.myshopify.comAll of our links here: https://linktr.ee/BShifter

A quiet epidemic is spreading, and it doesn't look like a fever. It looks like old dreams shelved, alarms snoozed, and a heart that once burned now running on dim. We name that sickness—Ye'ush, the giving up of hope—and we take it head on, not with slogans, but with a return to the core of Jewish identity: the will to keep fighting when it's still dark.We start by tracing the subtle signs of surrender that creep into adult life. The goal posts move, the expectations shrink, and “realistic” becomes code for “I stopped trying.” Then we turn to the story of Yaakov wrestling the angel. The blessing is not a trophy; it's a new name, Yisrael, “for you have fought.” That shift is everything. Outcomes belong to God; effort belongs to us. This lens reframes prayer, punctuality for minyan, learning with patience, building a career, and shaping character. The question is no longer “Did I win?” but “Did I fight today in a way that honors my soul?”We also revisit the early warning to Cain: why let your face fall when the path to repair runs through the next right act? The remedy for despair is structured action: small, protected habits that guard big values. Set a modest arrival buffer for tefillah and keep it. Fix a daily learning slot and let consistency outweigh intensity. Choose one trait to refine this month, track it with a cue, and reset quickly after slips. Measure progress by process, not perfection, and let streaks of honest effort build momentum. That is how we grind with hope in 2025—one deliberate rep at a time, anchored in the knowledge that we are Bnei Yisrael, the people who do not quit.If this message hit home, follow the show, share it with someone who needs a lift, and leave a quick review so more people find it. Tell us: what fight are you choosing to re-enter today?Support the showJoin The Motivation Congregation WhatsApp community for daily motivational Torah content!---------------- SUBSCRIBE to The Weekly Parsha for an insightful weekly talk on the week's Parsha. Listen on Spotify or 24six! Access all Torah talks and listen to featured episodes on our website, themotivationcongregation.org ----------------Questions or Comments? Please email me @ michaelbrooke97@gmail.com

This is one of our most impactful episodes ever, Ben Brady sits down with global sales authority and bestselling author  @PhilMJonesUK  whose book Exactly What to Say has reshaped how professionals communicate, influence, and guide critical decisions. This conversation became our most downloaded episode for a reason — it's timeless, tactical, and brutally relevant to every agent navigating today's complex real estate landscape.Phil breaks down the foundational idea behind his work: that the difference between good and great agents often comes down to knowing exactly what to say, when to say it, and how to make it count. He reveals why real estate professionals consistently struggle with unlearning outdated habits, how language choices impact trust, and what separates the agents who thrive from those who get left behind in shifting markets.Ben and Phil go deep into the psychology of buyers and sellers — fear, regret, indecision, ego — and how the best agents create clarity in moments where clients feel most overwhelmed. From mastering conversational “prefaces” to turning black-and-white questions into productive gray areas, Phil shares the precise word patterns that help agents de-escalate tension, unlock truth, and confidently guide clients through high-stakes decisions.If you've ever wanted a practical blueprint for influencing without manipulating, communicating without conflict, and winning clients through trust rather than pressure… this is the episode.⏱️ Timestamps & Key Topics[00:00:00] – Holiday rerun intro & why this episode still matters[00:00:51] – Why Phil Jones' frameworks resonate years later[00:02:34] – The difference between good and great communicators[00:04:49] – Why agents struggle with unlearning old habits[00:06:50] – Scripting vs. real conversations in real estate[00:09:07] – The three questions every client is trying to answer[00:12:10] – The mindset shift agents must make in today's market[00:17:01] – Why hard conversations get avoided — and what it costs[00:23:35] – Influence vs manipulation: the real difference[00:27:10] – How to enter conversations through the “side door”[00:32:48] – The power of softening statements (“Could it be possible…”)[00:37:08] – The famous Phil Jones pen story: articulating real value

Take a sneak peek at this month's Fertility and Sterility! Articles discussed this month are:   Articles: 1. The reproductive journey of women with obesity undergoing assisted reproductive technology: an analysis of 48,595 in vitro fertilization cycles in 31,829 women 2.  The reproductive endocrinology and infertility subspecialist: definition, training, and scope of practice in the United States 3. Clinical outcomes in patient-oriented strategies encompassing individualized oocyte number (POSEIDON) low-prognosis patients receiving in vitro fertilization / intracytoplasmic sperm injection treatment: a multi-center retrospective cohort study 4. Gonadotropin-releasing hormone antagonist protocol is associated with higher oocyte yield in young women at high risk for low oocyte retrieval: a retrospective study using three statistical methods 5. Outcomes of in vitro fertilization cycles with embryo donation compared with double gamete donation with cryopreserved donor oocytes 6. Leveraging anti-Müllerian hormone and metaphase II oocyte yield to improve counseling for oocyte cryopreservation outcomes 7. Effect of a one-step fast warming protocol on reproductive outcomes of vitrified-warmed blastocysts View the December 2025, Volume 124 Issue 6 of Fertility and Sterility at https://www.fertstert.org/issue/S0015-0282(25)X0013-3 View Fertility and Sterility at https://www.fertstert.org/  

Welcome to Episode 208 of Freedom In Five Minutes! Kevin from the Pro Sulum team takes the mic to deliver a no-BS breakdown of what's REALLY happening in the Managed Service Provider world as we head into 2026. Your MSP is about to pitch you a lot of "AI solutions" in the coming year. But here's the uncomfortable truth: most of it might be snake oil. Kevin reveals how to spot the difference between genuine AI transformation and expensive experiments being conducted on YOUR dime. If you're a business owner paying for IT services, this episode will save you thousands of dollars and countless headaches. Plus, you'll discover the ONE thing that must happen BEFORE you automate anything with AI (spoiler: almost everyone gets this wrong). What You'll Learn: ✅ The AWS MSP Pressure Cooker - Why Amazon is throwing "steroid-level" money at MSPs to sell you AI services (and what that means for your wallet) ✅ The One Question to Ask Your MSP - A simple test to determine if they're truly using AI or just practicing on your business ✅ Agentic AI: The Terminator of IT - The next-level automation that either becomes your best employee or your worst nightmare ✅ The "Intelligent Garbage" Problem - Why automating broken processes just creates chaos at 100x speed (and how to avoid it) ✅ Why QBRs Are Dead in 2026 - Stop accepting boring activity reports and start demanding Strategic AI Reviews that show real outcomes ✅ The Hidden Gap Your MSP Can't Fill - Why even the best IT providers can't systemize your operations (and who can) Key Quotes:

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Send us a textEver notice how hard you grip outcomes when you're nervous—then watch everything slip anyway? We dig into a counterintuitive truth that changed our lives: releasing control doesn't make you careless, it makes you effective. From sobriety to sales calls, first dates to job interviews, we connect the dots between patience, presence, and authenticity—and why expectations so often become premeditated resentments.We unpack the early myth of instant transformation in recovery and replace it with practical tools: sit with discomfort, practice consistently, and let time compound. Then we map those lessons to high-pressure moments at work. After a tough call, we walk through a fast reset: debrief the objections, reframe the story, ask for help if you need it, and step into the next conversation clean. You'll hear how a simple shift from outcome-chasing to service-first—What does this person need right now?—boosts trust, surfaces real blockers, and prevents you from carrying one loss into your next opportunity.Honesty sits at the center of all of it. We talk about shedding masks, staying the same person on and off the mic, and why misalignment breeds anxiety and churn in business and relationships. Not every prospect is your customer, not every match is your partner, and that's okay. When you respect fit, follow a sound process, and stay present, decisions come easier—and results often improve without the pressure. We close with gratitude for this community and a reminder that asking for help is not a failure of willpower but a pathway to connection and growth.If this resonated, follow the show, share it with a friend who needs a reset, and leave a quick review—what outcome are you letting go of this week? Support the show https://www.audible.com/pd/9-Simple-Steps-to-Sell-More-ht-Audiobook/B0D4SJYD4Q?source_code=ASSORAP0511160006&share_location=library_overflowhttps://www.amazon.com/Simple-Steps-Sell-More-Stereotypes-ebook/dp/B0BRNSFYG6/ref=sr_1_1?crid=1OSB7HX6FQMHS&keywords=corey+berrier&qid=1674232549&sprefix=%2Caps%2C93&sr=8-1 https://www.linkedin.com/in/coreysalescoach/

ECMO is the topic of this week's episode of Pediheart. We speak with Assistant Professor of Pediatrics and cardiac critical care specialist at Northwell Health, Dr. Ivana Capin about a recent ELSO database study she conducted to assess outcomes in single ventricle patients who were treated with ECMO prior to single ventricle palliation. What factors were associated with worse overall outcomes? Can this therapy be used to stabilize the HLHS patient with an intact atrial septum? Why have outcomes for this high risk patient group not appreciably improved in the recent decade? How can these data improve prognostic clarity when speaking with families in this difficult situation.Also joining us briefly is Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai, Dr. Scott Aydin to discuss his co-author and mentor, Dr. George Ofori-Amanfo as we approach the 4th anniversary of his untimely and tragic passing. DOI: 10.1017/S1047951125001386

We make our case for OU to hold its position as a CFP host as we await the conference title games. We preview those, discuss and rant on the CFP committee, and make predictions.Realist Deal Locks of the WeekSteve: Texas Tech -12.5, Georgia -2.5, North Texas -2.5 Conner: Jacksonville State -2.5, Western Michigan -1.5, North Texas -2.5 Lucas: Ohio State -4, Georgia -2.5, Virginia -3.5 Jay: Ohio State -4, Georgia -2.5, UNLV +4.5 Listener: Ohio State -4, Georgia -2.5, Tulane +2.5Prop Bet of the WeekDoes OU host a playoff game? Steve: YesConner: NoLucas: YesJay: YesThis Substack is reader-supported. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Two Homers and a Realist at twohomersandarealist.substack.com/subscribe

In the original Løvset maneuver (described for breech presentations), the fetus is rotated in one direction to facilitate arm delivery. For shoulder dystocia, the reverse Løvset applies rotation in the opposite direction—specifically rotating the posterior shoulder toward a "belly down" position through up to 180 degrees of rotation. These maneuvers were first described by Norwegian obstetrician Jørgen Løvset in the 1940s. Now, in the current November 2025 AJOG, this maneuver is back in the spotlight. In this episode, we will review the reverse Løvset maneuver for shoulder dystocia and review its effectiveness. Which maneuver is more likely to result in fetal brachial plexus injury? Listen in for details. 1. A critical evaluation of the external and internal maneuvers for resolution of shoulder dystocia, March 2024; AJOG. https://www.ajog.org/article/S0002-9378(23)00022-4/fulltext2. Grindheim, Sindre et al.Reverse Løvset maneuver for shoulder dystocia, American Journal of Obstetrics & Gynecology, Volume 233, Issue 5, 505.e1 - 505.e43. Leung TY, Stuart O, Suen SS, Sahota DS, Lau TK, Lao TT. Comparison of perinatal outcomes of shoulder dystocia alleviated by different type and sequence of manoeuvres: a retrospective review. BJOG. 2011 Jul;118(8):985-90. doi: 10.1111/j.1471-0528.2011.02968.x. Epub 2011 Apr 12. PMID: 21481159.4. Grobman WA, Miller D, Burke C, Hornbogen A, Tam K, Costello R. Outcomes associated with introduction of a shoulder dystocia protocol. Am J Obstet Gynecol. 2011;205(6):513−517.STRONG COFFEE PROMO CODE:https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Tune in to the most recent episode of Better Money Better World  with Daniel Pianko in a fascinating conversation about the future of agriculture and impact investing with Mark Lewis, Co-Founder and Managing Partner of Trailhead Capital.Regenerative agriculture isn't just a buzzword. It's emerging as a real poly solution to the so-called “polycrisis” impacting climate, water resources, biodiversity, and human health. Trailhead invests in technologies that enhance soil health, boost farmer profits, and deliver tangible environmental benefits.Whether you're a young professional or experienced investor, Mark Lewis advises: “Become a subject matter expert in something, build a really strong network, and learn the X's and O's as you go.” Passion and authentic engagement remain key in this transformative sector.Ready to learn more or get involved?Visit Impact Capital Managers to learn more about how investing for impact drives returns.More on Trailhead Capital at www.trailheadcap.com 

Depression affects how your body heals after surgery by increasing inflammation and weakening your immune defenses, which lead to longer recovery times and higher complication rates Older adults with cancer who also have depression experience significantly higher post-surgical costs — nearly $25,000 compared to about $17,500 for patients without depression — showing that untreated mental health directly impacts both recovery and finances In patients undergoing spine surgery, depression nearly doubled the risk of delirium and tripled the likelihood of blood clots or infections, underscoring how mood disorders influence physical outcomes Depression triggers systemic inflammation and disrupts hormonal balance, particularly through chronically high cortisol levels, which slow wound healing and increase blood pressure — key drivers of poor recovery Addressing depression before surgery — through dietary changes, gut support, regular movement, sunlight exposure, and consistent rest — helps restore your body's energy systems, reduces inflammation, and supports faster, more complete healing