Podcasts about outcomes

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.

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.

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.

A new report from the National Cancer Registry Ireland has found the Covid pandemic did not have a lasting impact on cancer diagnoses or deaths. To discuss this further was Professor Deirdre Murray, Director of The National Cancer Registry Ireland.

A new report from the National Cancer Registry Ireland has found the Covid pandemic did not have a lasting impact on cancer diagnoses or deaths. To discuss this further was Professor Deirdre Murray, Director of The National Cancer Registry Ireland.

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

Host: Ryan Quigley How are patients with breast cancer brain metastases faring in the modern treatment era? In this AudioAbstract, Ryan Quigley shares findings from a 25-year review of 507 patients at UCSF, providing new insights into how survival outcomes have shifted across subtypes and which treatments are driving real-world progress. This research was also presented at the 2025 San Antonio Breast Cancer Symposium.

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:

AP correspondent Donna Warder reports on the chilling, just-released 911 phone calls from July's deadly flooding in Texas.

All Episodes are inside Skyway Central©Click here to access your Contracting Officer Podcast 2.0 License and start listening today!

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

What if today's harvest is coming from seeds you didn't even realise you planted? This morning's message uncovers the quiet law shaping every outcome in your life. Listen to the principles that will help you shape your tomorrow.This devotional was aired on Radio HCI Today via the WeLove Radio App.

Join Professor Laura Coates and Phillip Mease as they discuss the top publications in the world of PsA. This month, the conversation covered the ‘the effectiveness and safety of upadacitinib with secukinumab and adalimumab' and ‘the efficacy of long-term treatment with risankizumab across the updated GRAPPA domains and key related conditions of PsA'.

Chinese Foreign Minister Wang Yi told his French counterpart Jean-Noel Barrot that as victorious nations in WWII, China and France should joingly safeguard the outcomes of the war and oppose Japan's attempts to stir up trouble using Taiwan as an excuse.

Amy McIver is in conversation with Willem Els from the Institute for Security Studies, about the standed SA soldiers in Russia. Presenter John Maytham is an actor and author-turned-talk radio veteran and seasoned journalist. His show serves a round-up of local and international news coupled with the latest in business, sport, traffic and weather. The host’s eclectic interests mean the program often surprises the audience with intriguing book reviews and inspiring interviews profiling artists. A daily highlight is Rapid Fire, just after 5:30pm. CapeTalk fans call in, to stump the presenter with their general knowledge questions. Another firm favourite is the humorous Thursday crossing with award-winning journalist Rebecca Davis, called “Plan B”. Thank you for listening to a podcast from Afternoon Drive with John Maytham Listen live on Primedia+ weekdays from 15:00 and 18:00 (SA Time) to Afternoon Drive with John Maytham broadcast on CapeTalk https://buff.ly/NnFM3Nk For more from the show go to https://buff.ly/BSFy4Cn or find all the catch-up podcasts here https://buff.ly/n8nWt4x Subscribe to the CapeTalk Daily and Weekly Newsletters https://buff.ly/sbvVZD5 Follow us on social media: CapeTalk on Facebook: https://www.facebook.com/CapeTalk CapeTalk on TikTok: https://www.tiktok.com/@capetalk CapeTalk on Instagram: https://www.instagram.com/ CapeTalk on X: https://x.com/CapeTalk CapeTalk on YouTube: https://www.youtube.com/@CapeTalk567 See omnystudio.com/listener for privacy information.

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 

Peter Jones, who heads up Revenue at Premion, returns to Insider Interviews (see Ep 38) to educate us on the shifts in local TV advertising in a streaming-first world -- and how small businesses can compete with national brands, with greater access to sports inventory, and why measurement actually matters! Learn what "context" really means for advertisers (spoiler: consumers don't experience media in silos), how the collapse of some Regional Sports Networks has created opportunities for local advertisers, and why "smart curation" is more than an industry buzzword. But it's not just the small business that needs to adapt: it's agencies and brands, too. Peter breaks down what full-funnel capabilities now available to SMBs—from maxing out brand awareness across Premion's 210 DMAs, to measurable sales transactions, tapping 1st and 3rd party data.  And, as we gear up for playoff sports, he reminds us how technology has leveled the playing field and that local advertisers can get in the game, too! So, sports puns are pervasive in Episode 44 since part of our conversation is about Premion's new(ish) programmatic options to enable more inventory for all in live sports. Talk about a “game changer...!” Understand how local car dealerships and furniture stores can now leverage the same targeting, data, and attribution tools that Fortune 500 companies use, all while reaching their specific communities with precision. But for everyone, it's key to understand the importance of creative in driving outcomes, and omnichannel strategies (because yes, we're all scrolling during halftime), and why advertisers need to embrace data-driven decisions over personal platform preferences. "The first thing to realize is that big tech has leveled the playing field for local advertisers..." Whether you're a media buyer, agency leader, or local business owner trying to navigate the CTV landscape, this conversation delivers practical guidance on inventory, data, and measurement—the three pillars every advertiser should evaluate when choosing a CTV partner. Bottom line? The local advertising opportunity in streaming TV has never been bigger—but only for those willing to adapt, measure outcomes over impressions, and follow consumers wherever they are. Key Highlights [01:15] CTV's double-digit growth, challenges and opportunities for advertisers [02:14] What Premion does – Nine years of helping local advertisers navigate CTV [03:33] Leveling the playing field – Educating SMBs on using the same tools as national brands [05:25] Challenges and Strategies for Outcomes in Omnichannel Advertising [08:26] Tools and tactics – First-party data, pixels, attribution, and what SMBs need to track [10:48] The role of creative – Sequential messaging, AI tools, and "message to market match" [12:52] How Premion's programmatic access to sports inventory is opening doors for local advertisers [15:39] Smart Curation Explained and Full Funnel Options in 200+ markets [20:22] The dynamic nature of live sports – Why planning can be tricky but opportunity is massive [21:45] What to look for in a CTV partner – Hint: Inventory, data, measurement (plus the TAG seal of approval!) [23:41] Emerging Trends and AI in Advertising Connect with Peter Jones and Premion Connect with E.B. Moss and Insider Interviews: With Media & Marketing Experts            LinkedIn: https://www.linkedin.com/in/mossappeal Instagram: https://www.instagram.com/insiderinterviews Facebook: https://www.facebook.com/InsiderInterviewsPodcast/ Threads: https://www.threads.net/@insiderinterviews If you enjoyed this episode, follow Insider Interviews, share with another smart business leader, and leave a comment on @Apple or @Spotify… or a tip in my jar!: https://buymeacoffee.com/mossappeal! 

Stack or Stall: Why Credentials Collapse but Ecosystems CompoundLast year's Chemistry Nobel went to non-chemists. The lasting power of domain-specific credentials is collapsing - but David Julian has seen this pattern before across four technological revolutions and knows what compounds instead. From Hotjobs.com to Google's global EdTech partnerships, Julian identified what separates transformative innovations from footnotes: they teach users something new, reduce friction, and fundamentally improve lives. Now on Harvard's Galileo Project steering committee, he's applying ecosystem logic to AI-powered astrophysics - and discovering why stacking beats selecting.The insight: Skills stack. Modular, complementary, and interoperable capabilities stack. Liberal arts + AI certifications compound income dramatically. Universities aren't obsolete - their business models are. Survivors become platforms for compounding, not gatekeepers of credentials.Paradigm Shifts:

In this episode, Gregory J. Tiesi, MD, FACS, FSSO, hosted a discussion about innovations in regional cancer therapies. Dr Tiesi is the medical director of Hepatobiliary Surgery at the Hackensack Meridian Jersey Shore University Medical Center in Toms River and Brick, New Jersey. He was joined by: Anthony Scholer, MD, FACS, FSSO, a surgical oncologist specializing in hepatobiliary surgery, at Hackensack Meridian Medical Group and Jersey Shore University Medical Center in Neptune, New Jersey Benjamin Jon Golas, MD, FACS, regional chief of Surgical Oncology for Hackensack Meridian Health's Central Region, surgical director of Oncology Services at Jersey Shore University Medical Center, vice chair of Surgery at Jersey Shore University Medical Center Cancer Surgery, and an associate professor of surgery at the Hackensack Meridian School of Medicine in Neptune and Edison, New Jersey Eric Pletcher, MD, a surgeon specializing in Complex General Surgical Oncology at Hackensack Meridian JFK University Medical Center in Edison Drs Tiesi, Scholer, Golas, and Pletcher chatted about the use of pressurized intraperitoneal aerosolized chemotherapy (PIPAC), a minimally invasive regional cancer therapy designed for patients with peritoneal metastases or primary peritoneal cancers. The experts explained that this laparoscopic approach overcomes several limitations of traditional systemic treatments by delivering aerosolized chemotherapy in fine droplets under high pressure into the peritoneal cavity. This process ensures uniform drug distribution and enhanced tissue penetration, allowing for efficacy with lower systemic drug concentrations, they noted.  PIPAC candidates typically present with unresectable or recurrent disease, or symptomatic malignant ascites, and should have an ECOG performance status between 0 and 2, they elaborated. The procedure, which is repeatable every 4 to 6 weeks, includes diagnostic laparoscopy, quantification of the peritoneal carcinomatosis index, and serial biopsies to assess treatment response. They emphasized that PIPAC has a favorable safety profile, with low 30-day mortality rates and minimal grade 3/4 adverse effects reported in clinical trials. Additionally, they stated that clinical data indicate high pathologic response rates and the potential for disease downstaging, enabling some patients who were initially deemed unresectable to become eligible for subsequent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Of note, the experts reported that PIPAC is designed to be integrated seamlessly with concurrent systemic therapy.

The foreign ministers of China and Russia have called for safeguarding the victorious outcomes of World War II, with the Chinese side urging continued cooperation to counter the provocative actions of Japan's far‑right forces (01:20). French President Emmanuel Macron is in Beijing for his three-day state visit to China (15:34). Russia says there is still no compromise plan to settle the conflict with Ukraine, despite a lengthy round of talks in Moscow between President Vladimir Putin and U.S. special envoy Steve Witkoff (20:15).

In today's episode, Fares breaks down a wild weekend in the world of combat sports.Starting with UFC Qatar, the Co-main sees Belal Muhammad suffer two eye pokes before getting outpointed by Ian Garry (1:43). Arman Tsarukyan continues to show why he's ahead of the rest of the contenders (6:34). Waldo Costa makes a real case for Fighter of the Year (13:42), leading into a debate: high-level MMA or high-level boxing (14:44)?Then we jump to the boxing world, where Riyadh Season delivered four title fights. Abdullah Mason becomes a newly crowned champion after a war with Sam Noakes (22:06). Fares' favorite fighter, Jesse “Bam” Rodriguez, captures another world title with a finish (25:02). Devin Haney shows surprising power up a weight class (27:47). And David Benavidez dominates in his third fight at the new weight before announcing he plans to move up again for his next bout (33:09)https://www.instagram.com/thehbpod_/

This episode dives into one of the most overlooked yet influential leadership skills: emotional pacing—the speed, tone, and intensity of your emotional responses in meetings, conversations, decisions, and crises. As the transcript reveals, your team's nervous system mirrors yours, and your emotional tempo has measurable effects on engagement, cognitive capacity, stress levels, and trust. Leaders who master emotional pacing don't just communicate better—they transform culture quietly and powerfully.Through research-backed insight, real-world examples, and actionable strategies, this episode breaks down how emotional pacing works, how it impacts high-performing teams, and how you can intentionally shift your tempo to lead with clarity, stability, and credibility.──────────────────────── Key Talking Points• Why every leader carries an “invisible metronome” that shapes team performance. • How your emotional tempo—fast, reactive, calm, or flat—affects trust, engagement, and stress. • Research from Yale, Stanford, and Gallup on how leaders' emotional tone influences team outcomes.  • Why your team shouldn't have to adapt to your emotional pace—and what great leaders do instead. • How to pre-decide your emotional pace before tough meetings, decisions, or conflict. • Practical techniques: pausing, breath work, voice pacing, body language calibration, and post-interaction emotional audits. • How intentional pacing creates psychological safety, resilience, and high performance.──────────────────────── Key Time Stamps00:00 – The Leader's Invisible Metronome01:00 – Emotional Pacing Defined02:00 – When Leadership Pace Becomes “Too Much”03:00 – What the Research Says06:00 – Overreacting vs. Underreacting10:00 – Real-World Example: The Underreactive VP15:00 – How to Deliver Difficult News Stabilizingly17:00 – Celebrations & Positive Energy18:00 – High-Pressure Decisions: The Power of Pausing20:00 – Conflict & Difficult Conversations22:00 – Techniques for Managing Your Pace31:00 – Final Leadership Reminder──────────────────────── Call to ActionIf this episode helped you rethink your leadership presence, follow the show so you never miss an episode. Share it with your colleagues or team to spark conversations about emotional intelligence and leadership effectiveness. Subscribe, like and follow at https://balloffirecoaching.com/podcastIf you're ready to assess your own emotional pace or want strategies to elevate your leadership impact, schedule a discovery call at: coachmebernadette.com/discoverycallYour team doesn't just hear your words—they ride your rhythm. Lead with the pace that elevates everyone around you.Support the show

Ablate before you radiate. Success with bone tumor ablation may have as much to do with your procedure technique as it does with your ability to collaborate. In this episode of BackTable MSK, interventional oncologist Dr. Damian Dupuy shares his approach to bone tumor ablation with host Dr. Kavi Krishnasamy, and offers practical advice on how to partner with your cancer care team to make ablation a viable treatment option. --- This podcast is supported by: Medtronic Osteocool https://www.medtronic.com/en-us/healthcare-professionals/products/surgical-energy/ablation/radiofrequency-ablation/systems/osteocool-2-0-bone-tumor-ablation-system.html --- SYNPOSIS The doctors review the history of bone ablation techniques, including radiofrequency and cryoablation modalities. They discuss the significance of targeting the bone-tumor interface for pain palliation and highlight several case studies to illustrate various techniques and successful outcomes. The conversation also touches upon the synergistic benefits of combining ablation with radiation therapy and emphasizes the importance of multidisciplinary collaboration in treating cancer patients. --- TIMESTAMPS 00:00 - Introduction02:07 - Dr. Dupuy's Start in Bone Ablation06:29 - Cryo vs. Microwave Therapies08:25 - Dr. Dupuy's Clinical Trial and Research Involvement 12:49 - Patient Selection and Treatment Strategies25:54 - Sedation and Anesthesia Practices in Bone Ablation28:46 - Treatment Approach: Oligometastases vs. Progressive Disease36:22 - Microwave Ablation in Bone: Future Prospects37:30 - Techniques for Treating Sclerotic and Lytic Lesions40:01 - Skin Protection Methods in Superficial Lesion Treatments41:49 - Reviewing Recent Clinical Trials: MOTION, OPuS One, and More52:35 - Case Studies: Achieving Effective Ablation Techniques01:08:08 - Final Thoughts and Recommendations --- RESOURCES Dr. Damian E. Dupuy, MD, FACRhttps://www.linkedin.com/in/damian-e-dupuy-md-facr-6b080b1b/ Solitary painful osseous metastases: correlation of imaging features with pain palliation after radiofrequency ablation--a multicenter american college of radiology imaging network studyhttps://pubmed.ncbi.nlm.nih.gov/23657892/ Radiofrequency Ablation Provides Rapid and Durable Pain Relief for the Palliative Treatment of Lytic Bone Metastases Independent of Radiation Therapy: Final Results from the OsteoCool Tumor Ablation Post-Market Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC10156864/ Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC8011449/ A Multi-Center Observational Trial of Symptomatic, High-Risk Bone Metastases Treated with Percutaneous Ablation and Palliative Radiation Therapy (TRIBUTE)https://clinicaltrials.gov/study/NCT06859801

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

Sébastien Page is the Chief Investment Officer at T. Rowe Price, one of the world's largest investment management firms. Sebastien oversees a team of investment professionals who manage more than $500 billion in assets, and he rose from a non-English-speaking intern to the C-suite. Sébastien is also the author of the book, The Psychology of Leadership.   In this episode we discuss the following: For the sports psychologist and 40-time national handball champ Daniel Zimet, his best match ever was a loss. Roger Federer, one of the greatest tennis players of all time, lost nearly half the points in his career. Outcomes are noisy, and are only loose signals of decision quality. True peak performance, whether in sports, investing, or life, isn't always about winning. It's about a relentless focus on the process. At the highest levels, listening beats speaking, strategic patience often beats knee-jerk decisiveness, and the courage to quit can matter more than blind persistence. None of this matters if we're running on empty. The foundation of sustained excellence is sleep, diet, and exercise.

Learn which HER2-targeted therapies are being evaluated for the first-line treatment of gastroesophageal adenocarcinoma. Credit available for this activity expires: 11/27/2026 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/her2-evolution-gastroesophageal-cancer-new-therapies-and-2025a1000x2t?ecd=bdc_podcast_libsyn_mscpedu

Have you ever wondered if your organization could deliver better results while giving people more freedom?  The Results-Only Work Environment (ROWE) from CultureRx asks leaders to shift the focus from time and location to measurable outcomes — but the change is as much cultural as it is operational. In this episode we cover: What ROWE looks like in practice and where it originated The leadership and measurement changes required to make results-first work The risks and common pitfalls — and how to design safeguards to protect collaboration and fairness We'll be breaking down the rest of all of these work models on future episodes, so subscribe to the podcast to make sure you don't miss out! And if you're a People or HR leader who wants a more detailed breakdown of the 12 distributed work models (and an easy framework to decide which works best for your organization)... Download a copy of our Distributed Work Success Playbook today!   TIMESTAMPS: [02:40] What are the origins of the Results-Only Work Environment (ROWE) model? [03:19] What are some of the key principles to applying a results-only workplace? [05:30] What are some of the most common challenges for this Distributed Work Model? [06:36] How to know if the ROWE model is best fit for your organization?   LINKS: info@inclusioninprogress.com www.inclusioninprogress.com/podcast www.linkedin.com/company/inclusion-in-progress  Download our Distributed Work Models Playbook to learn how to find the distributed work model that enables your teams to perform at their best. To learn more about how the Results-Only Work Environment Model (ROWE) got started and how you can apply it to your workplace, visit the CultureRX website. Visit Harvard Business Review to read more about how Best Buy's decision to rollback ROWE was an indicator of inconsistent leadership buy-in and scaling challenges.  Want us to partner with you on finding your best-fit hybrid work strategy? Get in touch to learn how we can tailor our services to your company's DEI and remote work initiatives. Subscribe to the Inclusion in Progress Podcast on Apple Podcasts or Spotify to get notified when new episodes come out! Learn how to leave a review for the podcast.

PREVIEW — Elizabeth Peek — The Two-Track American Economy: Retail Gains vs. Job Anxiety. Peakcharacterizes the American economy as a bifurcated system with starkly divergent outcomes. Upper-income earners express confidence regarding net worth and stock market performance. Conversely, substantial cohorts remain anxious about labor market conditions, evidenced by negative ADP private sector employment gains and college graduates facing difficulty securing positions. Positive retail indicators, notably Kohl's raising earnings guidance, provide counterbalancing economic optimism. 1885 Ohio River

Little Rooms: Why Scrappy Starts Create Standout Cash PT Clinics In this episode, Doc Danny Matta unpacks a simple but powerful idea inspired by Andre 3000's Rock & Roll Hall of Fame speech: "Little rooms. Great things start. Little rooms." He connects Outkast's legendary basement studio—The Dungeon—to the tiny subleased spaces where most cash PT clinics begin, and shows why those gritty starts are not a disadvantage, but an asset that sharpens your skills, your story, and your impact. Quick Ask If this episode encourages you to see your "little room" differently, share it with another clinician who's thinking about starting or growing a practice—and tag @dannymattaPT so he can reshare it. Episode Summary AI scribe advantage: Clair saves staff clinicians ~6 hours per week, freeing up time for patient visits and revenue growth. Math of time: Even 3 extra visits per week at $200/visit adds roughly $30,000/year in revenue per clinician. Little rooms concept: Inspired by Andre 3000's "little rooms" quote and Outkast's early days recording in The Dungeon. Outkast's origin: Teenagers making music in a carpet-lined basement in a rough Atlanta neighborhood, with no funding and no guarantees. Clinic parallels: Most cash PT clinics start in tiny, imperfect subleased spaces with limited resources. Danny's first space: A sketchy CrossFit sublease with break-ins, rats, building shutdowns, and bad client experience—but strong outcomes. Skill as your differentiator: In a little room, you can't hide behind fancy equipment or build-outs—your outcomes are the product. Art, not just career: Obsessing over outcomes, studying cases, seeking mentorship, and treating PT like your craft is what gets you out of the small room. Word-of-mouth "virality": When your results are unique, people can't help but talk about you—just like people shared Outkast's early music. Growth phases: Start gritty & clinical, then evolve into a real business owner—leader, hirer, systems builder, and operator at scale. Lessons & Takeaways Everyone starts small: Basements, garages, subleases, apartment gyms—"little rooms" are the norm, not the exception. Your environment doesn't define you: A rough space does not limit your upside if your outcomes are excellent. Constraints create creativity: Limited resources force you to get scrappy, sharpen your craft, and focus on what really matters. Obsess over outcomes: Losing sleep over stalled cases, studying, and improving is part of turning PT into your art. Your story is an asset: The weird, stressful, funny early days become the part of your story people remember and root for. New phase, new skills: Once you're busy, the game shifts from being a great clinician to becoming a strong owner and leader. Mindset & Motivation Don't be ashamed of your "shitty little room": No windows, rats, sketchy parking lots—it's all part of your origin story. Treat PT like art: Outcomes and the way you care for people should matter to you at a deeper level than "just a job." You can't hold talent down: Great outcomes and care are like a beach ball underwater—eventually they pop to the surface. Respect the grind: The start is hard and scary—but also fun, intense, and memorable. Remember where you came from: If you're in a bigger clinic now, don't forget to tell the story of your little room—it makes you relatable. Pro Tips for Clinic Owners Leverage an AI scribe: Use tools like Clair to pull 5–6 hours/week off your clinicians' plates and reinvest that time into patients or higher-level work. Focus on outcomes first: Before worrying about decor and equipment, make sure your results are undeniably better than the clinic down the street. Document your story: Take photos, jot notes, and remember the early days—you'll use this later in marketing, branding, and leadership. Invest in yourself: Study, read, get mentorship, and ask for help on tough cases—your skill set is your first real "marketing budget." Level up as you grow: Once your schedule is full, actively learn hiring, leadership, finance, systems, and SOPs. Notable Quotes "Little rooms. Great things start. Little rooms." – Andre 3000 "If you're in a little room, you can't hide your skill set. You have to be really good at what you do." "Your product is you. You need to obsess over it. It's got to be your art, not just your career." "You can't hold talent down. It's like trying to push a beach ball underwater—it's going to pop up eventually." "Don't be ashamed of your shitty little room with no windows and a rat above your head. Everybody's got to start somewhere." Action Items Run the math on your time: how many extra visits could you add with an AI scribe like Clair? Audit your outcomes: are your results meaningfully better than your local competition? Write down your "little room" story: where did you start, and what did you have to overcome? Commit to one learning action this week: a course, article deep dive, or mentor conversation about a tough case. If you're on the fence about starting, accept that your first space will be small—and start planning anyway. Programs Mentioned PT Biz Part-Time to Full-Time 5-Day Challenge (Free): Get crystal clear on how much money you need to replace, how many people you need to see, and the strategies to go from side hustle to full-time. Join here. Resources & Links PT Biz Website Free 5-Day PT Biz Challenge MeetClair AI — Free 7-day trial for PTs About the Host: Doc Danny Matta — physical therapist, entrepreneur, and founder of PT Biz and Athlete's Potential. He has helped over 1,000 clinicians start, grow, scale, and sometimes sell their cash practices, and is passionate about helping PTs turn their craft into true time and financial freedom.

Watch the YouTube version of this episode HEREAre you a law firm owner looking for advice on improving leadership? In this insightful episode of the Maximum Lawyer Podcast, Tyson interviews  lawyer and leadership consultant Noel Bagwell about personal experiences of resilience and rebuilding after major life changes, the importance of trust and communication in business, and his unique subscription-based legal model. Noel shares his insight on the importance of trust in legal practice and in leadership consulting. Both involve building and maintaining relationships with coworkers, counterparts and clients. It is important to be mindful of how you structure your relationships with people and how you navigate conflict. If you can develop trusting relationships, you can be informal with how to do business. But, it is crucial to still create strong, formal contracts with clients to keep things professional. Noel and Tyson chat about how to build confidence in yourself and clients. The first thing in achieving this is to understand your own competence. Think about what you excel in and what your weaknesses are, especially if you struggle with imposter syndrome. You need to rethink your mindset as it relates to yourself and your abilities. If there are areas of your firm that you are not strong in, such as contracts or intake, take some time to figure out a strong path forward to implement that change.Take a listen!2:20 AI, Simulation Theory, and Faith5:56 Leadership Failures and Legal Problems9:50 Strength, Masculinity, and Resilience14:44 Parenting, Self-Defense, and Channeling Energy16:21 Coaching, Focus, and Positive Guidance18:14 Virtue, Competence, and Trust in Law 22:42 Work-Life Fusion and Authenticity 24:37 Preventing Overwhelm and Setting Expectations32:57 Flat Fee vs. Hourly Billing43:35 Competence, Confidence, and Identity 48:12 Layers of Identity and BeliefTune in to today's episode and checkout the full show notes here. Connect with Noel:Website Linkedin 

PREVIEW — Husain Haqqani — Conclusions of Russia-Washington negotiations over Ukraine conflict. Haqqani examines the outcomes of U.S.-Moscow negotiations on the Ukraine conflict, predicting favorable conclusions for Russia and unfavorable ones for the United States. Should Russia succeed, its global player status returns, yet inherent suspicion of Russian intentions endures because they extract more than they contribute. The key negative outcome remains the perception that the U.S. is no longer a reliable ally that secures nations' freedom.

In this episode, the CardioNerds (Dr. Rachel Goodman, Dr. Shazli Khan, and Dr. Jenna Skowronski) discuss a case of AMI-shock with a focus on listing for heart transplant with faculty expert Dr. Kelly Schlendorf. We dive into the world of pre-transplant management, discuss the current allocation system, and additional factors that impact transplant timing, such as sensitization. We conclude by discussing efforts to increase the donor pool.  Audio editing for this episode was performed by CardioNerds Intern, Julia Marques Fernandes. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Heart Success Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls The current iteration of heart allocation listing is based on priority, with status 1 being the highest priority.  The are multiple donor and recipient characteristics to consider when listing a patient for heart transplantation and accepting a heart offer.  Desensitization is an option for patients who need heart transplantation but are highly sensitized.  Protocols vary by center.  Acceptance of DCD hearts is one of many efforts to expand the donor pool   Notes Notes: Notes drafted by Dr. Rachel Goodman  Once a patient is determined to be a candidate for heart transplantation, how is priority determined?  The current iteration of heart listing statuses was implemented in 2018.  Priority is determined by acuity, with higher statuses indicating higher acuity and given higher priority.  Status 1 is the highest priority status, and Status 7 is inactive patients. (1,2)  What criteria should be considered in organ selection when listing a patient for heart transplant?  Once it is determined that a patient will be listed for heart transplantation, there are certain criteria that should be assessed.  These factors may impact pre-transplant care and/or donor matching (3).  (1) PVR  (2) Height/weight   (3) Milage listing criteria  (4) Blood typing/cPRA/HLA typing  What is desensitization and why would it be considered?  Desensitization is an attempt to reduce or remove anti-HLA antibodies in the recipient.  It is done to increase the donor pool.  In general, desensitization is reserved for patients who are highly sensitized.  Desensitization protocols vary by transplant center, and some may opt against it.  When considering desensitization, it is important to note two key things: first, there is no promise that it will work, and second desensitization involves the use of immunosuppressive agents, thereby putting patients at increased risk of infection and cytopenia. (4)  Can you explain DCD and DBD transplant?  DBD: donor that have met the requirements for legal definition of brain death.   DCD: donors that have not met the legal definition of brain death but have been determined to have circulatory death.  Because the brain death criteria have not been met, organ recovery can only take place once death is confirmed based on cessation of circulatory and respiratory function. Life support is only withdrawn following declaration of circulatory death—once the heart has stopped beating and spontaneous respirations have stopped. (5,6)  References 1: Maitra NS, Dugger SJ, Balachandran IC, Civitello AB, Khazanie P, Rogers JG. Impact of the 2018 UNOS Heart Transplant Policy Changes on Patient Outcomes. JACC Heart Fail. 2023;11(5):491-503. doi:10.1016/j.jchf.2023.01.009  2:  Shore S, Golbus JR, Aaronson KD, Nallamothu BK. Changes in the United States Adult Heart Allocation Policy: Challenges and Opportunities. Circ Cardiovasc Qual Outcomes. 2020;13(10):e005795. doi:10.1161/CIRCOUTCOMES.119.005795  3:  Copeland H, Knezevic I, Baran DA, et al. Donor heart selection: Evidence-based guidelines for providers. J Heart Lung Transplant. 2023;42(1):7-29. doi:10.1016/j.healun.2022.08.030  4: Kittleson MM. Management of the sensitized heart transplant candidate. Curr Opin Organ Transplant. 2023;28(5):362-369. doi:10.1097/MOT.0000000000001096  5:  Kharawala A, Nagraj S, Seo J, et al. Donation After Circulatory Death Heart Transplant: Current State and Future Directions. Circ Heart Fail. 2024;17(7):e011678. doi:10.1161/CIRCHEARTFAILURE.124.011678  6: Siddiqi HK, Trahanas J, Xu M, et al. Outcomes of Heart Transplant Donation After Circulatory Death. J Am Coll Cardiol. 2023;82(15):1512-1520. doi:10.1016/j.jacc.2023.08.006