Podcasts about pearls

This week’s Pulm PEEPs Pearls episode is a focused discussion between Furf and Monty about non-pharmacologic techniques for airway clearance in the non-Cystic Fibrosis bronchiectasis population. This is a focused, high-yield discussion of the key points about airway clearance, including practical tips and a discussion of the evidence. This episode was prepared in conjunction with George Doumat MD. Goerge is an internal medicine resident at UT Southwestern and joined us for a Pulm PEEPs – BMJ Thorax journal club episode. He is now acting as a Pulm PEEPs Editor for the Pulm PEEPs Pearls series. Key Learning Points 1) Why airway clearance matters in non-CF bronchiectasis Non-CF bronchiectasis is defined by irreversible bronchial dilation with impaired mucociliary clearance, leading to mucus retention. Retained sputum drives the classic vicious cycle: mucus → infection → neutrophilic inflammation → airway damage → worse clearance. Airway clearance techniques (ACTs) are meant to interrupt this cycle, primarily by improving mucus mobilization and symptom control. 2) What ACTs are trying to achieve clinically Main benefits are: More effective sputum clearance Reduced cough/dyspnea burden Improved activity tolerance and quality of life Effects on spirometry are usually small. Exacerbation reduction is possible, but evidence is mixed—some longer-term data suggest benefit for specific techniques. 3) The main ACT “families” and when to use them Breathing-based techniques (device-free, flexible) ACBT (Active Cycle of Breathing Technique): breath control → deep breaths with holds → huffing. Pros: portable, adaptable, good first-line option. Key requirement: teaching/coaching to get technique right. Autogenic drainage: controlled breathing at different lung volumes to move mucus from peripheral → central airways. Pros: no device, can work well once learned. Cons: more technically demanding, needs training and practice. PEP / Oscillatory PEP (stents airways + “vibrates” mucus loose) PEP: back-pressure helps prevent small airway collapse during exhalation; often paired with huff/cough. Oscillatory PEP (Flutter/Acapella/Aerobika): adds oscillation that many patients find easy and satisfying to use. Good fit for: people who benefit from airway stenting, want something portable, and prefer a device. Mechanical/manual techniques (help when patient can't self-clear well) HFCWO (“the vest”): external chest wall oscillation; helpful for high sputum volumes, dexterity limits, or difficulty coordinating breathing maneuvers. Postural drainage/percussion/vibration: caregiver/therapist-assisted options; still useful but consider: GERD/reflux risk with certain positions Hemoptysis risk with vigorous techniques 4) How to choose the “right” technique (the practical framework) There is no one-size-fits-all. Match the tool to the patient: Sputum burden (volume/viscosity) Strength, coordination, cognition, dexterity Comorbidities (GERD, hemoptysis history, severe obstruction/airway collapse) Lifestyle + portability (what they'll actually do) Cost/access and availability of respiratory therapy/physio support A key mindset from the script: this is not a lifetime contract—reassess and adjust over time with shared decision-making. 5) Evidence takeaways (what improves, what doesn't) ACTs reliably improve sputum expectoration and often symptoms/QoL. QoL/cough scores (e.g., SGRQ, LCQ) tend to improve modestly, particularly with oscillatory PEP and some vest studies. Lung function: typically minimal change; occasional short-term FEV₁ benefit is reported in some vest trials. Exacerbations: mixed overall; the script highlights a longer-term RCT of ELTGOL showing fewer exacerbations at 12 months vs placebo exercises. Safety: generally excellent; main cautions are hemoptysis and reflux (depending on technique/positioning). 6) Special population pearls Hemoptysis / fragile airways: start with gentle breathing-based ACTs (ACBT, controlled huffing); avoid overly vigorous oscillatory/manual methods if concerned. Severe obstruction or early airway collapse: PEP/oscillatory PEP can help by keeping small airways open on exhalation. Mobility/coordination barriers: consider HFCWO vest or simple oscillatory PEP devices to enable daily adherence. During exacerbations: keep it simple—1–2 reliable techniques, prioritize daily consistency, and re-check technique. 7) The “real” bottom line Start with simple, self-manageable options (often ACBT ± PEP). The “best” ACT is the one the patient will do consistently. Reassess technique and fit over time; education and demonstration are part of the therapy. References and Further Reading  Lee AL et al., “Airway clearance techniques for bronchiectasis,” Cochrane Database Syst Rev. 2015; PMC7175838. PMID: 26591003. Athanazio RA et al., “Airway Clearance Techniques in Bronchiectasis,” Front Med (Lausanne). 2020; PMC7674976. PMID: 33251032. Iacono R et al., “Mucociliary clearance techniques for treating non-cystic fibrosis bronchiectasis,” Eur Rev Med Pharmacol Sci. 2015; PMID: 26078380. Polverino E et al., “European Respiratory Society statement on airway clearance techniques in bronchiectasis,” Eur Respir J. 2023; PMID: 37142337. Doumat G, Aksamit TR, Kanj AN. Bronchiectasis: A clinical review of inflammation. Respir Med. 2025 Aug;244:108179. doi: 10.1016/j.rmed.2025.108179. Epub 2025 May 25. PMID: 40425105.

Pastor Levi and Lisa talk about God being uncontainable but near, including how he revealed himself to Moses in the burning bush and to us through scripture, and how we can know his voice. This is an episode of Pearls & Swine on the Evangel Houghton Podcast from Evangel Community Church, Houghton, Michigan, January 6, 2026.

A student writes in asking whether they should focus on studying for the LSAT while having a low GPA. Ben and Nathan advise them to prioritize focusing on earning the best possible grades before beginning LSAT prep.Also in this episode:- A question about choosing between law schools with a $15,000 difference- Advice a student received from another prep company- When to send a letter of continued interestStudy with our Free Plan⁠⁠Download our iOS app⁠Watch Episode 540 on YouTubeCheck out all of our “What's the Deal With” segmentsGet caught up with our ⁠Word of the Week⁠⁠ library0:00 Test D Question “Animal Owners”  19:13 Things We Enjoy23:03 The $15,000 Difference33:43 Pearls v. Turds39:57 Leaving the Demon42:55 Focusing on Your GPA53:22 Retaking a 1751:05:18 When to Send a LOCI1:10:20 Word of the Week — flummoxed

Have you ever considered how a few carefully chosen words could shape your year, your energy, your decisions, and the way you experience life? In this annual tradition, we share our personal practice of choosing intention words for the year ahead. This isn't about goals or resolutions. It's about choosing how you want to be, move through, and live your life. This year's process was deeper, slower, and more nuanced than in past years.  Intention words act like a GPS for your nervous system. They offer clarity and direction through challenge, and how the right words if chosen with care can become some of your most transformative tools for personal and professional growth. Whether you're new to this practice or returning to it, you'll find inspiration, permission, and a deep sense of possibility. Pearls of Wisdom: Intentions are not goals, they're a mindful orientation. They work at the nervous system level to support aligned action and self-compassionate growth. Choosing multiple words (including a stretch word) adds richness and dimension. Life is complex, and your words can meet that with grace. Words should feel aligned, not performative. Let go of judgment, and choose words that support the version of yourself you're growing into. Words are powerful tools for decision-making. Ask yourself: Will this make me feel wealthy, healthy, strategic, or exquisite? This practice is most powerful when done with intention, over time, and often with support. It's subtle but profoundly transformative work Reflection Questions: How do you want to feel at the end of next year? What do you want to experience emotionally, physically, and in your relationships? What version of yourself are you growing into? What does she wear, how does she lead, how does she make decisions? If you'd like support in choosing your own intention words and integrating them into your year, I offer this process within all of my 1:1 coaching and group programs. This work is gentle, profound, and truly life-changing. If this episode resonates and you're ready to lead your life, your relationships, or your team more strategically, bravely, and exquisitely—join me in a coaching container or at a retreat. Explore retreats at www.jessiemahoneymd.com/retreats Learn about coaching at https://www.jessiemahoneymd.com/coaching If you'd like to bring this mindful approach to your team or conference, I'd be honored to speak or lead a workshop. Learn more at www.jessiemahoneymd.com/speaking For Dr. Ni-Cheng Liang's speaking and workshops, visit www.awakenbreath.org Nothing shared in the Healing Medicine Podcast is medical advice.  

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In this inspiring Parshas Vayechi review, Rabbi Aryeh Wolbe highlights Jacob's individualized blessings to each son and grandson—emphasizing uniqueness over uniformity—as a model for parenting and personal growth. No "cookie-cutter" approach: every child has distinct talents to nurture, rejecting worldly "equality" (equal outcomes) for Torah's equal potential.Central focus: the eternal Friday-night blessing "Yisimcha Elokim k'Ephraim v'chi'Menashe"—Ephraim and Menashe, raised in decadent Egypt yet remaining steadfastly Jewish, became exemplars of harmony, resilience, and spiritual elevation despite surroundings. Rabbi Wolbe reveals the deeper charge: to merit such children, parents must emulate Yosef—unwavering commitment, resisting temptation, seeing divine plan in adversity.The episode calls for "intentional Judaism": deliberate steps forward (Shabbos observance, kashrut, relationships) rather than stagnation or excuses. Small, consistent improvements—rejecting complacency—honor our unique potential, transforming challenges into growth. Rabbi Wolbe urges viewing life as ongoing journey, not destination, with Hashem guiding every step._____________This episode of the Parsha Review Podcast is dedicated in honor of Lenny & Teresa FriedmanDownload & Print the Parsha Review Notes:https://drive.google.com/drive/folders/1ncaRyoH5iJmGGoMZs9y82Hz2ofViVouv?usp=sharingRecorded at TORCH Meyerland in the Levin Family Studios (B) to a live audience on January 2, 2026, in Houston, Texas.Released as Podcast on January 2, 2026_____________Subscribe: Apple Podcasts (https://podcasts.apple.com/us/podcast/parsha-review-podcast-rabbi-aryeh-wolbe/id1651930083)Spotify (https://open.spotify.com/show/22lv1kXJob5ZNLaAl6CHTQ) to stay inspired! Share your questions at awolbe@torchweb.org or visit torchweb.org for more Torah content.  _____________About the Host:Rabbi Aryeh Wolbe, Director of TORCH in Houston, brings decades of Torah scholarship to guide listeners in applying Jewish wisdom to daily life.  To directly send your questions, comments, and feedback: awolbe@torchweb.org_____________Support Our Mission:Help us share Jewish wisdom globally by sponsoring an episode at torchweb.org. Your support makes a difference!_____________Subscribe and Listen to other podcasts by Rabbi Aryeh Wolbe: NEW!! Hey Rabbi! Podcast: https://heyrabbi.transistor.fm/episodesPrayer Podcast: https://prayerpodcast.transistor.fm/episodesJewish Inspiration Podcast: https://inspiration.transistor.fm/episodesParsha Review Podcast: https://parsha.transistor.fm/episodesLiving Jewishly Podcast: https://jewishly.transistor.fm/episodesThinking Talmudist Podcast: https://talmud.transistor.fm/episodesUnboxing Judaism Podcast: https://unboxing.transistor.fm/episodesRabbi Aryeh Wolbe Podcast Collection: https://collection.transistor.fm/episodesFor a full listing of podcasts available by TORCH at http://podcast.torchweb.orgFor a full listing of podcasts available by TORCH at http://podcast.torchweb.org_____________Keywords:#Torah, #Parsha, #Genesis, #Joseph, #Jacob, #Brotherhood, #Vayechi, #Yosef, #Ephraim, #Menashe, #Unique, #IntentionalJudaism, #Parenting, #SpiritualGrowth, #Shabbos, #Blessing ★ Support this podcast ★

In this inspiring Parshas Vayechi review, Rabbi Aryeh Wolbe highlights Jacob's individualized blessings to each son and grandson—emphasizing uniqueness over uniformity—as a model for parenting and personal growth. No "cookie-cutter" approach: every child has distinct talents to nurture, rejecting worldly "equality" (equal outcomes) for Torah's equal potential.Central focus: the eternal Friday-night blessing "Yisimcha Elokim k'Ephraim v'chi'Menashe"—Ephraim and Menashe, raised in decadent Egypt yet remaining steadfastly Jewish, became exemplars of harmony, resilience, and spiritual elevation despite surroundings. Rabbi Wolbe reveals the deeper charge: to merit such children, parents must emulate Yosef—unwavering commitment, resisting temptation, seeing divine plan in adversity.The episode calls for "intentional Judaism": deliberate steps forward (Shabbos observance, kashrut, relationships) rather than stagnation or excuses. Small, consistent improvements—rejecting complacency—honor our unique potential, transforming challenges into growth. Rabbi Wolbe urges viewing life as ongoing journey, not destination, with Hashem guiding every step._____________This episode of the Parsha Review Podcast is dedicated in honor of Lenny & Teresa FriedmanDownload & Print the Parsha Review Notes:https://drive.google.com/drive/folders/1ncaRyoH5iJmGGoMZs9y82Hz2ofViVouv?usp=sharingRecorded at TORCH Meyerland in the Levin Family Studios (B) to a live audience on January 2, 2026, in Houston, Texas.Released as Podcast on January 2, 2026_____________Subscribe: Apple Podcasts (https://podcasts.apple.com/us/podcast/parsha-review-podcast-rabbi-aryeh-wolbe/id1651930083)Spotify (https://open.spotify.com/show/22lv1kXJob5ZNLaAl6CHTQ) to stay inspired! Share your questions at awolbe@torchweb.org or visit torchweb.org for more Torah content.  _____________About the Host:Rabbi Aryeh Wolbe, Director of TORCH in Houston, brings decades of Torah scholarship to guide listeners in applying Jewish wisdom to daily life.  To directly send your questions, comments, and feedback: awolbe@torchweb.org_____________Support Our Mission:Help us share Jewish wisdom globally by sponsoring an episode at torchweb.org. Your support makes a difference!_____________Subscribe and Listen to other podcasts by Rabbi Aryeh Wolbe: NEW!! Hey Rabbi! Podcast: https://heyrabbi.transistor.fm/episodesPrayer Podcast: https://prayerpodcast.transistor.fm/episodesJewish Inspiration Podcast: https://inspiration.transistor.fm/episodesParsha Review Podcast: https://parsha.transistor.fm/episodesLiving Jewishly Podcast: https://jewishly.transistor.fm/episodesThinking Talmudist Podcast: https://talmud.transistor.fm/episodesUnboxing Judaism Podcast: https://unboxing.transistor.fm/episodesRabbi Aryeh Wolbe Podcast Collection: https://collection.transistor.fm/episodesFor a full listing of podcasts available by TORCH at http://podcast.torchweb.orgFor a full listing of podcasts available by TORCH at http://podcast.torchweb.org_____________Keywords:#Torah, #Parsha, #Genesis, #Joseph, #Jacob, #Brotherhood, #Vayechi, #Yosef, #Ephraim, #Menashe, #Unique, #IntentionalJudaism, #Parenting, #SpiritualGrowth, #Shabbos, #Blessing ★ Support this podcast ★

In this episode, Mike again teaches in the manner of charaz, the stringing together of pearls. Mike talks about the cost of discipleship, addresses some listener feedback, and he reads commandments for roommates!

In this episode, we get an update on Anti-Amyloid therapies and ARIA, along with the new POC tool to help physicians navigate these therapeutics and how they may impact patients in the emergency department. We talk with Dr. Christina Shenvi who introduced us to ARIA earlier in the year and now we have more evidence and a POC tool. Supported by Eli Lilly, USA

Since the first immunotherapy agent for lung cancer was approved in 2015, this class of drugs has captured the imagination and the narrative for the treatment of driver negative lung cancer. Immunotherapy is now the standard of care for most patients with lung cancer in some form. And while not all patients benefit, those that do, have the chance for transformative benefit. In today's episode, we focus not on the benefit of immunotherapy, which can be massive, but on the toxicity of immunotherapy. Guest: Dr. Jarushka Naidoo, a consultant medical oncologist at Beaumont Hospital Dublin and a Professor in the Royal College of Surgeons in Ireland. She currently serves as national lung cancer lead for Cancer Trials Ireland and serves on several international guideline panels including ASCO and SITC

What if one insight could shift the way you move into the new year? In this special episode, I've pulled together the most powerful “pearls of wisdom” shared by mediums, healers, and spiritual teachers from past Spirit Speakeasy episodes — the advice they wish they had known sooner on their intuitive and personal journeys.Inside, you'll hear quick, soul-hitting guidance on trusting your gifts, navigating doubt, moving through grief or dark seasons, strengthening your intuition, setting real energetic boundaries, and remembering who you are as you step into 2026.These 14 clips are short, honest, and deeply human — the kind of reminders that land exactly when you need them.You'll hear insights on:✨ How intuitive/spiritual gifts truly unfold ✨ Letting go of comparison + external validation ✨ Why challenges can become spiritual turning points ✨ The mindsets that support abundance, purpose, and alignmentI'd love to hear your pearl of wisdom too. Email your insight (and the story behind it) to admin@joyfulmedium.comand tell me if you'd like your name shared or kept private, and you may even hear your pearl on a future episode.And keep an eye on your email inbox — a powerful New Year reset experience is coming in late January.Join me Live on Zoom for my Free Monthly Community Healing session! You'll receive a blend of Reiki (Energy Healing), Chakra & Aura Clearing & Balancing, Color Healing, Grounding, Cord Cutting, Trance Medium Healing & more. Get all the details & Sign up now to receive the link and replay for the next session! https://www.joyfulmedium.com/EventsGet Joy's Free "Sign Magnet" 3 Day Mini Course HERE https://www.joyfulmedium.com/sign-magnetJoy's Website: www.joyfulmedium.comInstagram: @JoyfulMediumTikTok: @JoyfulMediumFacebook: @JoyfulMediumFacebook Group: Joy's Soul SpaYouTube: Psychic Medium Joy Giovanni

What if the very things you're hard on yourself about are actually strengths that are simply overused?  In this solo episode, I invite you to step into a new understanding of your patterns without judgment or shame. Explore the "overs" and the "toxics" which are the subtle (and not so subtle) ways our best traits become burdens when they're overdone. If you've ever been told you're too much, felt depleted by the traits that once helped you succeed, or wondered why awareness alone isn't shifting your patterns,  this episode is for you. Pearls of Wisdom: Many of your "admirable" qualities such as achievement, responsibility, or independence can become draining when taken too far. There's nothing wrong with you; you're just overdoing what once worked. Naming the "overs" (like overthinking, overdoing, overfunctioning) and the "toxics" (toxic productivity, toxic independence) brings both awareness and relief. It's not about fixing yourself; it's about finding your way back to balance. Awareness alone doesn't shift entrenched patterns. Real change happens in relationships with yourself, your nervous system, and others who can reflect your patterns back to you compassionately. Reflection Questions: What are you over right now? Which of your strengths has become emotionally or energetically expensive? What might become possible if you moved beyond consuming and started engaging with this work in a deeper, more embodied way?   If you're ready to move beyond listening and into transformation, join me for small group coaching or a nourishing retreat. Both are designed to help you unwind the "overs" and move from depletion to aligned ease.  Learn more at: www.jessiemahoneymd.com/coaching www.jessiemahoneymd.com/retreats If you'd like to invite me or Dr. Liang to speak or lead a workshop for your team, institution, or conference, learn here: www.jessiemahoneymd.com/speaking www.awakenbreath.org Nothing shared in the Healing Medicine Podcast is medical advice.  

This week we wrap up our two-part countdown of the Top Shows of 2025, highlighting the four conversations that stood out above the rest. These episodes focused on the fundamentals that shape real-world decisions on the ranch — from reexamining the true cost and scale of making hay, to revisiting key cattle market questions and what actually played out over the year. We also revisit a rare, multi-part discussion that challenged long-held beliefs about land, livestock, and stewardship, along with a practical framework for buying and selling cattle in a high-priced market. Together, these shows reflect the kind of thinking that helps producers stay disciplined and forward-looking in an uncertain industry. Links to Show: #4: Ep 226: Ten Reasons You Should Quit Making Hay #3: Ep 232: Revisiting the Four Big Cattle Market Questions w Dr. Kenny Burdine #2: Ep 201: Allan Savory – Part 1: Why Cows MUST be part of the Solution        Ep 202: Allan Savory – Part 2: Climate Change, Fossil Fuels, & Holistic Management         Ep 203: Allan Savory – Part 3: Pearls of Wisdom #1: Ep 197: What Should You Be Selling and Buying in this Market w/ Wally Olson #workingranchmagazine #ranchlife #ranching #dayweather #weather #agweather #beef #cows #livestock #cattle #Allflex #Neogen #IngentyBeef #TankToad #LongRangeDewormer #WorkingRanchRadio #BeefCattle #CowCalf #CattleManagement #Cattlemen #BeefProduction #RanchProfitability #RanchEconomics #CattleHealth #Ranchers #AgPodcast #RuralAmerica

As we wrap up the holiday season, join Denim and Pearls for a chat about New Year's resolutions and the art of setting goals. From personal growth to planning for the future, we dive into what truly matters. Tune in for insights, laughter, and a fresh perspective as we step into 2026. Don't miss out — like, share, and let us know your goals for the new year! #NewYearNewMe #DenimAndPearls #Goals #michellemras #brianswanson #ep242 #podcast #Teambuilidng

Aldosterone antagonists, such as spironolactone and eplerenone, are potassium-sparing diuretics that block aldosterone at the mineralocorticoid receptor in the distal nephron. By reducing sodium and water reabsorption while conserving potassium, they play a key role in heart failure, resistant hypertension, and primary hyperaldosteronism. Clinically, they improve mortality in heart failure with reduced ejection fraction, making them much more than just “add-on” diuretics. From a safety standpoint, the biggest concerns with aldosterone antagonists are hyperkalemia and renal function decline. These risks increase in patients with chronic kidney disease or when combined with ACE inhibitors, ARBs, or potassium supplements. Spironolactone can also cause endocrine-related adverse effects such as gynecomastia and menstrual irregularities, which is why eplerenone may be preferred in some patients. Direct-acting vasodilators, most notably hydralazine and minoxidil, lower blood pressure by relaxing arteriolar smooth muscle and reducing systemic vascular resistance. Hydralazine is commonly used in heart failure in combination with nitrates, particularly in select patient populations, while minoxidil is reserved for severe, refractory hypertension due to its potency. Despite their effectiveness, direct-acting vasodilators come with important clinical trade-offs. Reflex tachycardia and fluid retention are common, so they are typically prescribed alongside a beta blocker and a diuretic. Hydralazine is associated with drug-induced lupus, while minoxidil can cause significant edema and hypertrichosis, making careful patient selection and monitoring essential. Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE! Support The Podcast and Check Out These Amazing Resources! NAPLEX Study Materials BCPS Study Materials BCACP Study Materials BCGP Study Materials BCMTMS Study Materials Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated) Guide to Drug Food Interactions (Amazon Best Seller) Pharmacy Technician Study Guide by Meded101

In this Parshas Vayigash review, Rabbi Aryeh Wolbe focuses on the climactic moment when Yosef reveals himself to his brothers: “I am Yosef—is my father still alive?”—a revelation so shocking the brothers are speechless, realizing the entire 22-year saga (their sale of Yosef, his suffering, and rise to power) was Hashem's precise plan. The brothers' terror mirrors the future Day of Judgment, when Hashem will reveal “I am Hashem” and everything in history will suddenly make perfect sense.Rabbi Wolbe emphasizes the wake-up call: we sell our potential for fleeting gains (like the brothers sold Yosef for shoes' worth of silver), wasting time on distractions (social media, materialism) instead of prioritizing Torah, mitzvot, family, and spiritual growth. He urges laser focus on what truly matters—relationships, legacy, and eternal investment—warning that Hashem will hold us accountable not against others, but on whether we maximized our unique selves. The episode closes with a call to realign priorities daily through prayer and conscious living._____________This episode of the Parsha Review Podcast is dedicated in honor of Lenny & Teresa FriedmanDownload & Print the Parsha Review Notes:https://drive.google.com/drive/folders/1ncaRyoH5iJmGGoMZs9y82Hz2ofViVouv?usp=sharingRecorded at TORCH Meyerland in the Levin Family Studios (B) to a live audience on December 23, 2025, in Houston, Texas.Released as Podcast on December 24, 2025_____________Subscribe: Apple Podcasts (https://podcasts.apple.com/us/podcast/parsha-review-podcast-rabbi-aryeh-wolbe/id1651930083)Spotify (https://open.spotify.com/show/22lv1kXJob5ZNLaAl6CHTQ) to stay inspired! Share your questions at awolbe@torchweb.org or visit torchweb.org for more Torah content.  _____________About the Host:Rabbi Aryeh Wolbe, Director of TORCH in Houston, brings decades of Torah scholarship to guide listeners in applying Jewish wisdom to daily life.  To directly send your questions, comments, and feedback: awolbe@torchweb.org_____________Support Our Mission:Help us share Jewish wisdom globally by sponsoring an episode at torchweb.org. Your support makes a difference!_____________Subscribe and Listen to other podcasts by Rabbi Aryeh Wolbe: NEW!! Prayer Podcast: https://prayerpodcast.transistor.fm/episodesJewish Inspiration Podcast: https://inspiration.transistor.fm/episodesParsha Review Podcast: https://parsha.transistor.fm/episodesLiving Jewishly Podcast: https://jewishly.transistor.fm/episodesThinking Talmudist Podcast: https://talmud.transistor.fm/episodesUnboxing Judaism Podcast: https://unboxing.transistor.fm/episodesRabbi Aryeh Wolbe Podcast Collection: https://collection.transistor.fm/episodesFor a full listing of podcasts available by TORCH at http://podcast.torchweb.org_____________Keywords:#Torah, #Parsha, #Genesis, #Joseph, #Vayigash, #YosefReveals, #IAmYosef, #HashemsPlan, #Priorities, #WakeUpCall, #SpiritualGrowth ★ Support this podcast ★

In this Parshas Vayigash review, Rabbi Aryeh Wolbe focuses on the climactic moment when Yosef reveals himself to his brothers: “I am Yosef—is my father still alive?”—a revelation so shocking the brothers are speechless, realizing the entire 22-year saga (their sale of Yosef, his suffering, and rise to power) was Hashem's precise plan. The brothers' terror mirrors the future Day of Judgment, when Hashem will reveal “I am Hashem” and everything in history will suddenly make perfect sense.Rabbi Wolbe emphasizes the wake-up call: we sell our potential for fleeting gains (like the brothers sold Yosef for shoes' worth of silver), wasting time on distractions (social media, materialism) instead of prioritizing Torah, mitzvot, family, and spiritual growth. He urges laser focus on what truly matters—relationships, legacy, and eternal investment—warning that Hashem will hold us accountable not against others, but on whether we maximized our unique selves. The episode closes with a call to realign priorities daily through prayer and conscious living._____________This episode of the Parsha Review Podcast is dedicated in honor of Lenny & Teresa FriedmanDownload & Print the Parsha Review Notes:https://drive.google.com/drive/folders/1ncaRyoH5iJmGGoMZs9y82Hz2ofViVouv?usp=sharingRecorded at TORCH Meyerland in the Levin Family Studios (B) to a live audience on December 23, 2025, in Houston, Texas.Released as Podcast on December 24, 2025_____________Subscribe: Apple Podcasts (https://podcasts.apple.com/us/podcast/parsha-review-podcast-rabbi-aryeh-wolbe/id1651930083)Spotify (https://open.spotify.com/show/22lv1kXJob5ZNLaAl6CHTQ) to stay inspired! Share your questions at awolbe@torchweb.org or visit torchweb.org for more Torah content.  _____________About the Host:Rabbi Aryeh Wolbe, Director of TORCH in Houston, brings decades of Torah scholarship to guide listeners in applying Jewish wisdom to daily life.  To directly send your questions, comments, and feedback: awolbe@torchweb.org_____________Support Our Mission:Help us share Jewish wisdom globally by sponsoring an episode at torchweb.org. Your support makes a difference!_____________Subscribe and Listen to other podcasts by Rabbi Aryeh Wolbe: NEW!! Prayer Podcast: https://prayerpodcast.transistor.fm/episodesJewish Inspiration Podcast: https://inspiration.transistor.fm/episodesParsha Review Podcast: https://parsha.transistor.fm/episodesLiving Jewishly Podcast: https://jewishly.transistor.fm/episodesThinking Talmudist Podcast: https://talmud.transistor.fm/episodesUnboxing Judaism Podcast: https://unboxing.transistor.fm/episodesRabbi Aryeh Wolbe Podcast Collection: https://collection.transistor.fm/episodesFor a full listing of podcasts available by TORCH at http://podcast.torchweb.org_____________Keywords:#Torah, #Parsha, #Genesis, #Joseph, #Vayigash, #YosefReveals, #IAmYosef, #HashemsPlan, #Priorities, #WakeUpCall, #SpiritualGrowth ★ Support this podcast ★

Dive into decision support tools and management options for primary care mental health conditions that often stump the primary care clinician.

Pastor Levi and Lisa talk about why we seek, but the Light has already come into the world, including that darkness covers the people, needing obedience before clarity, and when seeking turns to worship. This is an episode of Pearls & Swine on the Evangel Houghton Podcast from Evangel Community Church, Houghton, Michigan, December 23, 2025.

Here's Part 2 of the Best Moments of 2025 from the Pearls of Wisdom jewelry podcast—continuing the powerful stories and insights shaping the jewelry industry. This collection begins with Episode 88 at the Atlanta Jewelry Show, where Joanna Gruver shares the importance of networking, growth, and genuine industry connection. Episode 89 highlights Worthmore Jewelers' 32-year journey built on family, creativity, and constant evolution. In Episode 90, Bill Warren opens up about his path from jeweler to business coach, offering wisdom shaped by experience and reinvention. Episode 91 features Doris Butler's honest perspective on balancing truth and customer expectations in modern jewelry retail. Episode 92 celebrates Evan Deutsch's 30-year commitment to community and connection at the Atlanta Jewelry Show, while Episode 93 follows Dalton Powell's inspiring rise from employee to owner—bolstered by mentorship and vision. Retail trends and the rise of lab-grown diamonds take center stage in Episode 94 with Brian and Susan Barnes. Episode 95 shines a light on Melissa Mor's creative journey building the Mrs. Push brand and honoring motherhood through jewelry. Episode 96 brings Chuck Frey's insight on transitions, liquidations, and the changing future of independent jewelers. Family, fashion, and timeless sparkle define Episode 97 with Holland Jewelers, followed by Todd Malcolm's story of legacy and love in Episode 98. Episode 99 captures the resilience of Robinson Family Jewelers, while Episode 100 celebrates John Carter's leadership and the evolution of Jack Lewis Jewelers. The series closes with Episode 101's look at Guy Pineda's leadership transition at Southern Jewelry News and Episode 102, where Daniela Sokolowski shares her heart-led vision and artistic journey at DiCuore. Together, these episodes showcase the brilliance, grit, and heart powering the jewelry industry's future. Brought to you by: Southern Jewelry News: https://southernjewelrynews.com/    Jewelry Store Marketers: https://jewelrystoremarketers.com/    Learn more about the Pearls of Wisdom Jewelry Podcast https://southernjewelrynews.com/podcast   Subscribe on your favorite podcast platform:   • Apple Podcast = https://podcastsconnect.apple.com/my.-..   • Amazon Music/Audible = https://www.audible.com/pd/Pearls-of.-..   • iHeartRadio = https://www.iheart.com/podcast/263-pe...   • Spotify = https://open.spotify.com/show/6IU1OHw...   • Google Podcast = https://podcasts.google.com/feed/aHR0...  

Merch and apparel is now available through an exclusive collaboration with Confetti & Cloth Boutique! Comfortable and stylish sweatshirts, hats, coffee mugs, and more! Available while supplies last. Find them on Instagram, Facebook, and their website! Jill's episode for you this week is a brief, heartfelt check-in that is perhaps perfectly timed for the current holiday season! Listen in as she opens up about a sudden family health crisis - her mother-in-law, usually healthy, having fallen seriously ill and spending several days on a ventilator. Amidst the worry and unpredictability, Jill brings listeners into a personal conversation about presence, perspective, and finding grounding even when life throws curveballs! Jill reminds listeners that holidays rarely unfold perfectly according to plan. Rituals and traditions can anchor us, but they aren't always enough when unexpected challenges come up. She encourages listeners to step out of the comparison game - the "should haves" and "could haves" - and to instead find safety and calm within ourselves. Breathing, pausing, and acknowledging the moment can transform how we experience the holidays, even when circumstances aren't what we had hoped. Drawing from her own experiences, Jill also shares a simple but powerful lesson about embracing spontaneity. A plan to enjoy Christmas lights with her grandson didn't go as as the Norman Rockwell perfection she had imagined - no hot cocoa, just the joy they found together which far exceeded her expectations. It's truly never too late to create meaningful holiday experiences, even if they're different from what you had envisioned! This episode of Be YOU also, of course, explores the metaphor of the pearl born from irritation inside an oyster. Jill reflects on how challenges, pain, and unexpected disruptions can produce something beautiful when we face them fully, acknowledging and working through the difficulties rather than avoiding them. The pearls aren't the pain itself but rather what emerges when we engage with it consciously! Listeners of the show are invited to reflect on their own "pearls" this holiday season and to approach the coming year with awareness and gratitude, and Jill signs off with warm holiday wishes and a preview of the annual year-end episode, where she'll guide listeners in uncovering the lessons, growth, and gifts of 2025 before stepping into the new year! Also, don't forget - Jill will be hosting an upcoming retreat - the More of Me retreat - offering a deep dive into self-discovery. Head to jillherman.com for more details! Show Notes: [1:29] - Jill opens up about a family health crisis and encourages finding safety and calm within oneself. [4:52] - Jill models embracing spontaneity and finding joy in imperfect holiday moments such as unexpected Christmas lights. [6:59] - Jill reminds listeners that it's never too late to savor small, meaningful holiday experiences. [8:20] - When acknowledged, pain and challenges can transform into something beautiful, like a pearl forming. [10:33] - Jill invites reflection on life's "pearls" and previews the annual episode celebrating lessons from 2025. Rate, Review, & Follow on Apple Podcasts "I love Be You Podcast!" ← If that sounds like you, please consider rating and reviewing my show! This helps the podcast reach more people just like you. Click here, scroll to the bottom, tap to rate with five stars, and select "Write a Review." I know there was something in this episode that you were meant to hear. Let me know what that is! Also, if you haven't done so already, follow Be You Podcast. There is a new episode every single week, and if you're not following, there's a good chance you'll miss out.

As we celebrate five years of the Healing Medicine podcast, this episode is a reflection on what has truly sustained us—intention, alignment, and choosing with awareness.  Together, we explore how consistency rooted in love, not obligation, leads to energy, creativity, and sustainability. We share personal stories about letting go, taking pauses, and returning to what feels alive.  This conversation is also a joyful announcement: our Connect in Nature Retreat is returning July 30–August 2, 2026. It's a decision made not out of expectation, but because we missed it, and because we chose it again. Whether you're feeling weary from "pushing through" or simply curious about a gentler way to stay committed, this episode offers a new lens and a powerful invitation to rechoose, realign, and return to yourself.     Pearls of Wisdom: Sustainability isn't about willpower, it's about choosing with presence and letting alignment lead. Feelings of resistance or resentment are gentle cues to pause, reevaluate, and possibly release. Healing happens when we release the pressure to perform and give ourselves permission to rest and evolve. Fun, ease, and joy aren't frivolous, they are wise signals of what's truly aligned. Spaciousness, non-judgment, and collaboration support the longevity of meaningful work.     Reflection Questions: Where in your life are you being consistent by force, rather than by choice? What would it feel like to choose instead of push? Which commitments feel alive and which might be asking for a pause, a shift, or a graduation? Where could more lightness or joy gently be welcomed in?   Why Connect in Nature is a Different Kind of Retreat Connect in Nature is unlike any other retreat I offer. It is the only opportunity to work in person with both Dr. Ni-Cheng Liang and Dr. Jessie Mahoney. It's intentionally designed for healers, physicians, and wellness professionals who crave a reset rooted in nature, mindfulness, and joy. Held at the Green Gulch Zen Center just north of San Francisco, you'll be surrounded by eucalyptus groves, redwoods, gardens, and the quiet beauty of the California coast. Here's what makes it special: Nature as co-teacher: Forest bathing, beach meditation, and fog hikes support nervous system healing. Freedom to choose: All practices are optional and guided with non-judgment—you participate in what serves you. Spaciousness: Core retreat hours are 10:30–3:30, with optional morning offerings and space for rest, reflection, or local exploration. Inclusive and welcoming: Open to all genders and professions—bring a partner, a colleague, a friend, or come solo. Choose your own lodging at local inns, allowing for private rest and personal integration. This retreat isn't about pushing yourself. It's about letting nature and mindfulness gently bring you home. Join us July 30–August 2, 2026 at Green Gulch Zen Center.   And yes—it's over my birthday weekend, and there's no better way to celebrate than in community, in nature, and in joy. Retreat details + registration: www.jessiemahoneymd.com/retreats     Our Birthday Wish is to Help More Healers Find This Work As part of celebrating five years of the Healing Medicine podcast, we'd love to ask for your help in spreading this healing ripple even further: If this podcast has supported you... Please leave us a written review and a 5-star rating on your favorite listening platform. It helps others find the show and tells the algorithms to share this with more people who need it. Recommend it to a friend or colleague. Send them your favorite episode. Share it in your Facebook group, department, or residency class. Let someone know how it's helped you—that personal sharing is how this work continues to grow. This podcast was born out of love, and continues because of you. We are so grateful you are here.     If you're longing for more intention and joy in your life and career, I invite you to explore mindful coaching with me: www.jessiemahoneymd.com/coaching To bring this kind of healing to your institution, department, or medical team, learn more about my speaking offerings: www.jessiemahoneymd.com/speaking Dr. Ni-Cheng Liang also offers powerful keynotes, workshops, and wellness sessions through www.awakenbreath.org We would love to meet you this summer in the redwoods, and help you reconnect to what's truly meaningful. Nothing shared in the Healing Medicine podcast is medical advice.  

Sunday Morning

In this Parsha Review episode on Parshas Vayeishev, Rabbi Aryeh Wolbe explores the story of Yosef as a paradigm of divine guidance amid human challenges. Yosef, described as an "Ish Matzliach" (successful man) whose every endeavor prospered because "Hashem was with him," rose from slave to overseer in Potiphar's house—yet when entrusted with everything except "the bread he ate," the Torah abruptly notes Yosef's handsome appearance. Rashi explains Yosef began beautifying himself out of pride in his sudden success, forgetting his father Yaakov's mourning; Hashem responded with the ultimate test—Potiphar's wife's seduction—to realign his priorities.Rabbi Wolbe emphasizes that all events, even painful ones from people, are Hashem's precise "midah k'neged midah" (measure for measure) messages for growth, not random cruelty. Wicked messengers like Nebuchadnezzar (called "My servant") or historical evils fulfill decrees but are punished for volunteering malice. Prayer, teshuva, and mitzvot allow us to change decrees before they fully manifest, as Yosef did by resisting temptation and earning the title "Yosef HaTzaddik."True greatness invites profound challenges—the deeper the pit (literally for Yosef), the higher the ascent. Spiritual growth isn't steady but full of ups and downs; success follows the greatest struggles, mirroring a living heartbeat rather than a flatline. As long as we're "above the grass," we can embrace challenges, repent, and rise._____________This episode of the Parsha Review Podcast is dedicated in honor of Lenny & Teresa FriedmanDownload & Print the Parsha Review Notes:https://drive.google.com/drive/folders/1ncaRyoH5iJmGGoMZs9y82Hz2ofViVouv?usp=sharingRecorded at TORCH Meyerland in the Levin Family Studios (B) to a live audience on December 16, 2025, in Houston, Texas.Released as Podcast on December 19, 2025_____________Subscribe: Apple Podcasts (https://podcasts.apple.com/us/podcast/parsha-review-podcast-rabbi-aryeh-wolbe/id1651930083)Spotify (https://open.spotify.com/show/22lv1kXJob5ZNLaAl6CHTQ) to stay inspired! Share your questions at awolbe@torchweb.org or visit torchweb.org for more Torah content.  _____________About the Host:Rabbi Aryeh Wolbe, Director of TORCH in Houston, brings decades of Torah scholarship to guide listeners in applying Jewish wisdom to daily life.  To directly send your questions, comments, and feedback: awolbe@torchweb.org_____________Support Our Mission:Help us share Jewish wisdom globally by sponsoring an episode at torchweb.org. Your support makes a difference!_____________Subscribe and Listen to other podcasts by Rabbi Aryeh Wolbe: NEW!! Prayer Podcast: https://prayerpodcast.transistor.fm/episodesJewish Inspiration Podcast: https://inspiration.transistor.fm/episodesParsha Review Podcast: https://parsha.transistor.fm/episodesLiving Jewishly Podcast: https://jewishly.transistor.fm/episodesThinking Talmudist Podcast: https://talmud.transistor.fm/episodesUnboxing Judaism Podcast: https://unboxing.transistor.fm/episodesRabbi Aryeh Wolbe Podcast Collection: https://collection.transistor.fm/episodesFor a full listing of podcasts available by TORCH at http://podcast.torchweb.org_____________Keywords:#Torah, #Parsha, #Genesis, #Joseph, #Challenges, #prayer, #repentance, #divineguidance, #growth ★ Support this podcast ★

In this Parshas Miketz review—always read on Shabbos Chanukah—Rabbi Aryeh Wolbe uncovers the profound link between Pharaoh's disturbing dreams and the miracle of Chanukah. Pharaoh dreams of seven gaunt cows devouring seven robust ones, and seven thin, scorched ears swallowing seven healthy stalks—images that shatter his worldview where the strong always overpower the weak, the many dominate the few, and the beautiful prevail. This reversal terrifies him, as it defies the "laws of nature" he knows.The rabbi explains that Pharaoh's nightmare encapsulates Jewish history: the Jewish people, perpetually the few, the weak, and the persecuted, miraculously overcome mighty empires—from Greece in the Chanukah story to countless assaults over 2,000 years (with scarcely a decade without pogroms, expulsions, or blood libels). Chanukah celebrates precisely this reversal: the weak Maccabees defeating the vast Greek army, the pure overcoming the impure, and a single cruse of oil burning for eight days.Just as Pharaoh's dream disturbed the natural order, Jewish survival and triumph defy logic—proving Hashem's direct intervention. Our mission is not physical conquest but spiritual illumination: proudly displaying the menorah, living Torah values openly, and thanking Hashem ceaselessly for both light and darkness, success and challenge. Shabbos candles even take precedence over Chanukah lights for the sake of shalom bayis (peace in the home), underscoring that harmony is the foundation for all miracles._____________This episode of the Parsha Review Podcast is dedicated in honor of Lenny & Teresa FriedmanDownload & Print the Parsha Review Notes:https://drive.google.com/drive/folders/1ncaRyoH5iJmGGoMZs9y82Hz2ofViVouv?usp=sharingRecorded at TORCH Meyerland in the Levin Family Studios (B) to a live audience on December 19, 2025, in Houston, Texas.Released as Podcast on December 19, 2025_____________Subscribe: Apple Podcasts (https://podcasts.apple.com/us/podcast/parsha-review-podcast-rabbi-aryeh-wolbe/id1651930083)Spotify (https://open.spotify.com/show/22lv1kXJob5ZNLaAl6CHTQ) to stay inspired! Share your questions at awolbe@torchweb.org or visit torchweb.org for more Torah content.  _____________About the Host:Rabbi Aryeh Wolbe, Director of TORCH in Houston, brings decades of Torah scholarship to guide listeners in applying Jewish wisdom to daily life.  To directly send your questions, comments, and feedback: awolbe@torchweb.org_____________Support Our Mission:Help us share Jewish wisdom globally by sponsoring an episode at torchweb.org. Your support makes a difference!_____________Subscribe and Listen to other podcasts by Rabbi Aryeh Wolbe: NEW!! Prayer Podcast: https://prayerpodcast.transistor.fm/episodesJewish Inspiration Podcast: https://inspiration.transistor.fm/episodesParsha Review Podcast: https://parsha.transistor.fm/episodesLiving Jewishly Podcast: https://jewishly.transistor.fm/episodesThinking Talmudist Podcast: https://talmud.transistor.fm/episodesUnboxing Judaism Podcast: https://unboxing.transistor.fm/episodesRabbi Aryeh Wolbe Podcast Collection: https://collection.transistor.fm/episodesFor a full listing of podcasts available by TORCH at http://podcast.torchweb.org_____________Keywords:#Torah, #Parsha, #Genesis, #Joseph, #Chanukah #Miketz #Pharaoh, #Dreams, #Miracles, #Weak, #Strong, #Hanukkah, #JewishHistory, #Divine, #Light, #Darkness, #ShalomBayis ★ Support this podcast ★

In this Parsha Review episode on Parshas Vayeishev, Rabbi Aryeh Wolbe explores the story of Yosef as a paradigm of divine guidance amid human challenges. Yosef, described as an "Ish Matzliach" (successful man) whose every endeavor prospered because "Hashem was with him," rose from slave to overseer in Potiphar's house—yet when entrusted with everything except "the bread he ate," the Torah abruptly notes Yosef's handsome appearance. Rashi explains Yosef began beautifying himself out of pride in his sudden success, forgetting his father Yaakov's mourning; Hashem responded with the ultimate test—Potiphar's wife's seduction—to realign his priorities.Rabbi Wolbe emphasizes that all events, even painful ones from people, are Hashem's precise "midah k'neged midah" (measure for measure) messages for growth, not random cruelty. Wicked messengers like Nebuchadnezzar (called "My servant") or historical evils fulfill decrees but are punished for volunteering malice. Prayer, teshuva, and mitzvot allow us to change decrees before they fully manifest, as Yosef did by resisting temptation and earning the title "Yosef HaTzaddik."True greatness invites profound challenges—the deeper the pit (literally for Yosef), the higher the ascent. Spiritual growth isn't steady but full of ups and downs; success follows the greatest struggles, mirroring a living heartbeat rather than a flatline. As long as we're "above the grass," we can embrace challenges, repent, and rise._____________This episode of the Parsha Review Podcast is dedicated in honor of Lenny & Teresa FriedmanDownload & Print the Parsha Review Notes:https://drive.google.com/drive/folders/1ncaRyoH5iJmGGoMZs9y82Hz2ofViVouv?usp=sharingRecorded at TORCH Meyerland in the Levin Family Studios (B) to a live audience on December 16, 2025, in Houston, Texas.Released as Podcast on December 19, 2025_____________Subscribe: Apple Podcasts (https://podcasts.apple.com/us/podcast/parsha-review-podcast-rabbi-aryeh-wolbe/id1651930083)Spotify (https://open.spotify.com/show/22lv1kXJob5ZNLaAl6CHTQ) to stay inspired! Share your questions at awolbe@torchweb.org or visit torchweb.org for more Torah content.  _____________About the Host:Rabbi Aryeh Wolbe, Director of TORCH in Houston, brings decades of Torah scholarship to guide listeners in applying Jewish wisdom to daily life.  To directly send your questions, comments, and feedback: awolbe@torchweb.org_____________Support Our Mission:Help us share Jewish wisdom globally by sponsoring an episode at torchweb.org. Your support makes a difference!_____________Subscribe and Listen to other podcasts by Rabbi Aryeh Wolbe: NEW!! Prayer Podcast: https://prayerpodcast.transistor.fm/episodesJewish Inspiration Podcast: https://inspiration.transistor.fm/episodesParsha Review Podcast: https://parsha.transistor.fm/episodesLiving Jewishly Podcast: https://jewishly.transistor.fm/episodesThinking Talmudist Podcast: https://talmud.transistor.fm/episodesUnboxing Judaism Podcast: https://unboxing.transistor.fm/episodesRabbi Aryeh Wolbe Podcast Collection: https://collection.transistor.fm/episodesFor a full listing of podcasts available by TORCH at http://podcast.torchweb.org_____________Keywords:#Torah, #Parsha, #Genesis, #Joseph, #Challenges, #prayer, #repentance, #divineguidance, #growth ★ Support this podcast ★

In this Parshas Miketz review—always read on Shabbos Chanukah—Rabbi Aryeh Wolbe uncovers the profound link between Pharaoh's disturbing dreams and the miracle of Chanukah. Pharaoh dreams of seven gaunt cows devouring seven robust ones, and seven thin, scorched ears swallowing seven healthy stalks—images that shatter his worldview where the strong always overpower the weak, the many dominate the few, and the beautiful prevail. This reversal terrifies him, as it defies the "laws of nature" he knows.The rabbi explains that Pharaoh's nightmare encapsulates Jewish history: the Jewish people, perpetually the few, the weak, and the persecuted, miraculously overcome mighty empires—from Greece in the Chanukah story to countless assaults over 2,000 years (with scarcely a decade without pogroms, expulsions, or blood libels). Chanukah celebrates precisely this reversal: the weak Maccabees defeating the vast Greek army, the pure overcoming the impure, and a single cruse of oil burning for eight days.Just as Pharaoh's dream disturbed the natural order, Jewish survival and triumph defy logic—proving Hashem's direct intervention. Our mission is not physical conquest but spiritual illumination: proudly displaying the menorah, living Torah values openly, and thanking Hashem ceaselessly for both light and darkness, success and challenge. Shabbos candles even take precedence over Chanukah lights for the sake of shalom bayis (peace in the home), underscoring that harmony is the foundation for all miracles._____________This episode of the Parsha Review Podcast is dedicated in honor of Lenny & Teresa FriedmanDownload & Print the Parsha Review Notes:https://drive.google.com/drive/folders/1ncaRyoH5iJmGGoMZs9y82Hz2ofViVouv?usp=sharingRecorded at TORCH Meyerland in the Levin Family Studios (B) to a live audience on December 19, 2025, in Houston, Texas.Released as Podcast on December 19, 2025_____________Subscribe: Apple Podcasts (https://podcasts.apple.com/us/podcast/parsha-review-podcast-rabbi-aryeh-wolbe/id1651930083)Spotify (https://open.spotify.com/show/22lv1kXJob5ZNLaAl6CHTQ) to stay inspired! Share your questions at awolbe@torchweb.org or visit torchweb.org for more Torah content.  _____________About the Host:Rabbi Aryeh Wolbe, Director of TORCH in Houston, brings decades of Torah scholarship to guide listeners in applying Jewish wisdom to daily life.  To directly send your questions, comments, and feedback: awolbe@torchweb.org_____________Support Our Mission:Help us share Jewish wisdom globally by sponsoring an episode at torchweb.org. Your support makes a difference!_____________Subscribe and Listen to other podcasts by Rabbi Aryeh Wolbe: NEW!! Prayer Podcast: https://prayerpodcast.transistor.fm/episodesJewish Inspiration Podcast: https://inspiration.transistor.fm/episodesParsha Review Podcast: https://parsha.transistor.fm/episodesLiving Jewishly Podcast: https://jewishly.transistor.fm/episodesThinking Talmudist Podcast: https://talmud.transistor.fm/episodesUnboxing Judaism Podcast: https://unboxing.transistor.fm/episodesRabbi Aryeh Wolbe Podcast Collection: https://collection.transistor.fm/episodesFor a full listing of podcasts available by TORCH at http://podcast.torchweb.org_____________Keywords:#Torah, #Parsha, #Genesis, #Joseph, #Chanukah #Miketz #Pharaoh, #Dreams, #Miracles, #Weak, #Strong, #Hanukkah, #JewishHistory, #Divine, #Light, #Darkness, #ShalomBayis ★ Support this podcast ★

Random Thoughts - Holiday Humor and Heartfelt Stories with Denim and Pearls 241Join Denim and Pearls as we have a hilarious holiday message for everyone. This is an episode where all the craziness comes out of us both. Merry ChristmasHappy HolidaysAll things for the season#denimandpearlslive #podcast #michellemras #brianswanson #teambuilding #HolidayFun #Christmas

If you have just one podcast on your holiday listening list, this is it ¬— our Cross Examining Cyber: 2025 Summer Wrapped Podcast Special. In this episode, we bring together highlights from the last 12 months. Pearls of wisdom from our various podcast guests including the National Cyber Security Coordinator, Lt Gen Michelle McGuinness, CyberCX's Alistair MacGibbon, Karen Kukoda from Google Mandiant, CEO of the AICD Mark Rigotti, Tamir Maltz (Australia's leading cyber injunction barrister), Bruce Tonkin (CEO of auDA) and our very own Carolyn Pugsley, Christine Wong and Peter Jones. This is Cross Examining Cyber's 2025 Summer Wrapped Podcast Special. Here we go…

Send us a textGrab your trainers, your dog lead, or even shake your jingle bells, and join us for some free CPD as we have another relaxed round up of recent Red Whale primary care Pearls of wisdom. In the second of two episodes this month, Fi and Nik discuss: It's beginning to look a lot like…flu season. There's been a LOT of media coverage on seasonal influenza over the past few weeks. But aside from flu jabs, are you confident in where we would use antivirals? We look at the criteria for giving antivirals: for treatment, for prophylaxis, and the evidence behind it.“I would like a blood test to check I am well…” What do you do with this request? We share a handy framework to help, and think about how ‘just ticking a box' could cause a lot of work down the line!Listen as soon as you can to ensure you have full access to all the free resources. Useful LinksUKHSA guideline (2025): treatment and prophylaxis of influenza GP Trainee Essentials support package information, and the Red Whale CalendarSend us your feedback podcast@redwhale.co.uk or send a voice message Sign up to receive Pearls here. Pearls are available for 3 months from publish date. After this, you can get access them plus 100s more articles when you buy a one-day online course from Red Whale OR sign up to Red Whale Unlimited. Find out more here. Follow us: X, Facebook, Instagram, LinkedInDisclaimer: We make every effort to ensure the information in this podcast is accurate and correct at the date of publication, but it is of necessity of a brief and general nature, and this should not replace your own good clinical judgement, or be regarded as a substitute for taking professional advice in appropriate circumstances. In particular, check drug doses, side-effects and interactions with the British National Formulary. Save insofar as any such liability cannot be excluded at law, we do not accept any liability for loss of any type caused by reliance on the information in this podcast....

This podcast is designed to help pharmacy and nursing learners cut through the noise and focus on the high-yield concepts that matter most when it comes to angiotensin receptor blockers (ARBs) and thiazide diuretics. These two medication classes show up constantly on exams and in clinical practice, yet small details about their mechanisms, adverse effects, and monitoring parameters are often where test questions try to trip you up. Each episode is built to reinforce those key points in a clear, practical way. We'll break down how ARBs and thiazide diuretics work, why they are commonly used in hypertension and other disease states, and how to quickly differentiate them from similar drug classes. Special attention is given to classic exam “gotchas,” such as electrolyte changes, renal considerations, and patient populations where these medications are especially beneficial or should be used with caution. Beyond test prep, this podcast emphasizes real-world practice pearls that translate directly to patient care. You'll hear concise explanations of what to monitor, what side effects matter most clinically, and how to recognize problems early. These insights are especially helpful for nurses, pharmacy students, and new clinicians who want to feel confident applying pharmacology knowledge at the bedside or in clinic. Whether you're studying for boards, preparing for a pharmacology exam, or just looking to sharpen your clinical skills, this podcast delivers focused, high-yield content in an easy-to-follow format. By the end of each episode, you'll walk away with practical takeaways that improve both your test performance and your day-to-day medication management. Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE! Support The Podcast and Check Out These Amazing Resources! NAPLEX Study Materials BCPS Study Materials BCACP Study Materials BCGP Study Materials BCMTMS Study Materials Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated) Guide to Drug Food Interactions (Amazon Best Seller) Pharmacy Technician Study Guide by Meded101

Here is the Part 1 of the Best Moments of 2025 from the Pearls of Wisdom jewelry podcast, a curated collection of standout conversations that highlight the passion, craftsmanship, and community spirit shaping our industry. This special episode revisits key insights from Episodes 75 through 87, beginning with Episode 75, where Slav Galkin shares why authenticity and a growth mindset remain essential in a constantly evolving field. In Episode 76, the team at Pierce Custom Jewelers gives listeners an inside look at building trust through craft and genuine connection. Episode 77 then takes us "From Hot Rods to Heirlooms," an inspiring journey of a master jeweler whose path is as unique as his creations. Episode 78 features Irina Aran from Facets Fine Jewelry, whose resilience and artistry define her brand. Episode 79 turns to digital growth, as Parker Jewelers reveals how SEO is helping them drive more traffic and reach more customers online. Episodes 80 and 81 highlight the stories of Mike, Elise, and Babs—each demonstrating the value of legacy, balance, and authenticity in both business and life. In Episode 82, Cliff shares how grit, grace, and kindness built his family's jewelry legacy. Episode 83 follows with a heartfelt look at the journey from apprentice to artisan—an inspiring reminder of the power of patience, passion, and innovation. Episode 84 features Mike Kanoff discussing legacy, expansion, and the importance of work-life balance, while Episode 85 brings Aleah Arundale's refreshing honesty about building community and protecting jewelers. This Part 1 collection closes with the warmth and insight of Elesa Dillon in Episode 86 and Beth from Conti Jewelers in Episode 87—whose leadership and dedication continue to raise the standard in the jewelry world. Together, these stories reflect the brilliance behind every jeweler, every journey, and every piece.   Brought to you by: Southern Jewelry News: https://southernjewelrynews.com/  Jewelry Store Marketers: https://jewelrystoremarketers.com/    Learn more about the Pearls of Wisdom Jewelry Podcast https://southernjewelrynews.com/podcast    Subscribe on your favorite podcast platform: • Apple Podcast = https://podcastsconnect.apple.com/my.-.. • Amazon Music/Audible = https://www.audible.com/pd/Pearls-of.-.. • iHeartRadio = https://www.iheart.com/podcast/263-pe... • Spotify = https://open.spotify.com/show/6IU1OHw... • Google Podcast = https://podcasts.google.com/feed/aHR0...  

Bryan Matthews, Caleb Jones and Jay G. Tate reconvene to discuss the most pressing news, which today centers around Alex Golesh essentially finishing off his staff for 2026. (And it's a damn good one.) Also: Larry Scott brings a TON of experience to the table at TE. Larry Porter knows Auburn, knows how to recruit, is very good. Tim Banks might be the steal of this staff. Auburn has several guys headed to the portal. Who are the toughest hits? What is Auburn getting in OL Bear McWhorter? What happened with this 2026 signing class? Who gets the (dis)credit? The Fightin' Pearls clawed out a win against Chattanooga. Tahaad Pettiford sure plays well on the road! The weekend game against Purdue will be another major test. Shoutouts. The show is presented by VooDoo Wing Company with locations in Auburn, Mobile, Tuscaloosa, Florence, suburban Charlotte, Chapel Hill and Las Vegas. Check them out IN PERSON for delicious chicken or on the web at www.voodoowingco.com.

How a Teen and Her Mom Turned Breathwork Into a Book for Kids. This episode shares the story of how a teen and her mom turned breathwork into a book for kids. Inhale, Exhale, Shoot is a beautifully illustrated children's book born from a mindful mother-daughter collaboration. Co-written by integrative psychiatrist Dr. Holly MacKenna and her 13-year-old daughter, Maeve Graffanini, the book is a gentle guide to teaching kids mindfulness through the language of basketball, breath, and big emotions. Whether you're a parent, teacher, or someone passionate about helping children regulate emotions, this conversation offers a fresh, creative way to connect. It's a powerful reminder that when we pause to breathe, we open the door to presence, empathy, and resilience for children and ourselves. We also explore how creative projects, especially ones shared across generations, can become meaningful tools for healing, growth, and impact. Pearls of Wisdom: Teaching kids to breathe through big feelings is one of the most powerful lifelong gifts we can offer. What looks like anger in children is often something deeper like fear, anxiety, or overwhelm. Mindfulness helps us meet the root emotion. Creative metaphors, like basketball, can make mindfulness more accessible, relatable, and fun for kids. Co-creating a book strengthened Holly and Maeve's relationship and helped them navigate life's significant transitions together. Mindfulness isn't just a solo practice but something we can model, share, and co-create with those we love. Reflection Questions: When a child in your life has a big emotion, how do you usually respond? Could a breath shift the interaction? What projects or practices bring you closer to your children or your inner child? How might you integrate creative mindfulness practices into your family or classroom? Stay for the mindful moment at the end, where you'll be invited to enjoy a few breaths with us.     If you would like to donate a copy of Inhale, Exhale, Shoot to a child who needs it, you can do so this month for just $15 at susanschadtpress.com. Maeve and her school's service club are hand-delivering these books to shelters in New Orleans—mindfulness in action. If you would like to order a copy as a holiday gift, the book is available on Amazon or at susanschadtpress.com.  For those craving a reset and deeper embodiment of these practices, join me for a retreat where mindfulness, rest, and healing come alive in community. Upcoming dates are at www.jessiemahoneymd.com/retreats. To bring these kinds of mindful, compassionate conversation to your organization, team, or conference, Dr. Mahoney offers keynote talks and workshops on emotional awareness, leadership, and well-being. Visit www.jessiemahoneymd.com/speaking. Dr. Ni-Cheng Liang also offers breath-centered workshops and speaks on mindfulness and medicine. Learn more about her work at www.awakenbreath.org. Nothing shared in the Healing Medicine Podcast is medical advice.  

How We Got the King James Bible: https://youtu.be/qAilfG-IFQg?si=Ihu1zSCqweDtMhKtMike, Debi, Nathan and Ashley Pearl answer questions sent in from viewers00:00 Start01:06 Kirk Cameron changes his view on Hell18:25 How should Christians respond to the Bondi massacre?28:24 Possible issue from co-sleeping 34:36 Is the NASB more accurate than the KJB?52:01 Help for phone addiction1:00:53 Is born again the same as being saved?1:03:23 Can you explain Luke 19:27?1:05:18 Should a mom take self-care?

Pastor Levi and Lisa talk about how King Herod sought Jesus with a hard heart. This is an episode of Pearls & Swine on the Evangel Houghton Podcast from Evangel Community Church, Houghton, Michigan, December 16, 2025.

Mike, Debi, Nathan and Ashley Pearl answer questions sent in from viewers.00:00 Start01:35 Will children that die grow up in heaven?14:12 Will we have servants in heaven?15:45 How to protect your family from ungodly family members.24:35 Should a Christian carry a gun?42:48 Why did God accept Abel's offering but not Cain's?53:03 How can you spot true obedience in children?57:31 How did the early church interpret the gift of tongues?59:23 Tips to keep a 4 year old boy busy and out of trouble.

Listen to today's podcast... This day is a day of encouragement and inspiration. National Wear Your Pearls Day was created by best-selling author and motivational speaker DeAnna Bookert to celebrate life after she emerged from a deep depression. She said, “I wear pearls as a reminder that I have purpose and value,”. We are reminded that one irritating grain of sand can cause an iridescent pearl to form.  National Wear Your Pearls Day reminds us that when life throws dirt our way, we can take that dirt build on it and turn it into something meaningful and precious. Pearls symbolize wisdom acquired through experience and represent new beginnings. Take One Action Today To Build Your #Resiliency!      So here are today's Tips For Building Resiliency and Celebrating Wear Your Pearls Day: Embrace the beauty of your life, a beauty that is often formed through hardships and trials. And when life throws dirt your way, put on your pearls. Looking for more tips to build your resiliency? Look for my book on Amazon called Stress Out. 52 Weeks To Letting More Life In #mentalhealth #hr

What makes a pearl so mesmerizing, and what is it really? What exactly is a pearl made of, and how does it form inside a mollusk? Can a grain of sand truly cause a perfect pearl? What's the difference between a natural pearl and the cultured ones we see today? How do pearls get their stunning array of colors, from soft pinks to deep blacks? What makes certain pearls incredibly valuable, fetching millions? ... we explain like I'm five Thank you to the r/explainlikeimfive community and in particular the following users whose questions and comments formed the basis of this discussion: emoposer, iamkunii, cooldrummer1208, Albres, discordant_rhyme, xentonian, enzio901, n19h7m4r3 To the ELI5 community that has supported us so far, thanks for all your feedback and comments. Join us on Twitter: https://www.twitter.com/eli5ThePodcast/ or send us an e-mail: ELI5ThePodcast@gmail.com

It's complicated when love and medical expertise collide. In this deeply personal and heartfelt episode, I share the story of becoming a grandmother—twice over—to beautiful twin girls born at home. As a pediatrician, this choice was outside the guidance I was trained to give. Yet, it was fully aligned with my son and daughter-in-law's values. This experience, and others like it, have invited me into profound reflection on what it means to love fully while letting go of control. We explore how to navigate the emotional terrain of being a doctor when family members, adult children, aging parents, and siblings make health decisions that differ from our training or advice. This episode is a powerful guide for healthcare professionals who find themselves caught between the desire to protect and the practice of presence. Whether your expertise is welcomed or dismissed, this conversation is about staying connected, grounded, and compassionate, even when it's complicated. Pearls of Wisdom: Medical advice and love are not the same and withholding advice can sometimes be the most loving choice. Connection is medicine. Staying in a relationship often matters more than being "right." Your role in your family isn't to be "the doctor,"  AND  it's hard for our minds to step out of being "a doctor." When your medical expertise isn't invited or followed, your role is to love, connect, and stay present simply. Offering guidance is not always loving and sometimes withholding advice is the greater gift of compassion and trust. Mindfulness allows us to notice our urges to control, advise, or correct and choose connection instead. Letting go of being "right" opens space for peace, gratitude, and trust in both the medical process and our loved ones' autonomy. Cultural, generational, and spiritual influences often shape health decisions and awareness of these differences can invite compassion and curiosity. Practicing mindful boundaries in families allows for more ease, trust, and authenticity. Reflection Questions: Where do you feel the urge to protect, control, or advise and what is that urge trying to offer you? What might shift when you ask yourself: What would love do? What would trusting your loved one, or yourself, look like in this moment?   If this episode speaks to you, and/or you find yourself exhausted from being the expert in your family or navigating strained medical dynamics with those you love, I invite you to explore coaching or join me on retreat. Together, we can untangle the emotional weight of "doctoring" your loved ones and find a more easeful way forward: www.jessiemahoneymd.com/coaching www.jessiemahoneymd.com/retreats If you'd like to bring this conversation to your institution, team, or medical conference, I offer speaking and workshop opportunities that bring the themes of this episode—mindful connection, autonomy, and healing—into the workplace: www.jessiemahoneymd.com/speaking To invite Dr. Ni-Cheng Liang to speak or lead mindfulness offerings, visit: www.awakenbreath.org Nothing shared in the Healing Medicine Podcast is medical advice.  

Welcome to today's episode, where we dive into two cornerstone classes of antihypertensives: ACE inhibitors and calcium channel blockers. These drugs are among the most frequently prescribed agents in both primary care and specialty settings, making a solid understanding of their practical nuances essential for clinicians, pharmacists, and learners alike. In this episode, we'll break down the most important clinical pearls that can immediately improve your prescribing confidence and patient care. We'll start with ACE inhibitors, a class often selected for patients with hypertension, heart failure, diabetes, and chronic kidney disease. While widely effective, ACE inhibitors come with monitoring requirements and predictable side effect profiles that clinicians must recognize early. We'll highlight what changes in renal function are acceptable, how to navigate issues like hyperkalemia and cough, and when switching to an ARB may be the safest option. Next, we'll move into calcium channel blockers, emphasizing the differences between dihydropyridines and non-dihydropyridines—two groups with distinct effects and unique considerations. I outline amlodipine’s adverse effects and how to navigate a patient who is experiencing edema. By the end of this episode, you'll walk away with a set of high-yield, easy-to-apply pearls that you can use in your next patient encounter. If you use antihypertensives and treat hypertension, heart failure, arrhythmias, or chronic kidney disease, this episode will help sharpen your understanding of these foundational therapies and elevate your medication management strategies. Let's get started. Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE! Support The Podcast and Check Out These Amazing Resources! NAPLEX Study Materials BCPS Study Materials BCACP Study Materials BCGP Study Materials BCMTMS Study Materials Meded101 Guide to Nursing Pharmacology (Amazon Highly Rated) Guide to Drug Food Interactions (Amazon Best Seller) Pharmacy Technician Study Guide by Meded101

Today's Case A 20-year-old female presents to her primary care doctor over summer break complaining of worsening fatigue for the past 6 months. She is constantly tired and lacks the energy to do her usual summer activities with her friends. She denies associated weight loss, heat/cold intolerance, anhedonia, drug use, menorrhagia, unprotected sexual contacts, shortness of breath, skin rashes, or joint swelling. She does report mild episodes of diarrhea but it is well controlled with loperamide as needed. She states that she is a vegan since she started college to avoid the “freshman 15.” Fruits, vegetables, cereals, and pastas are now the cornerstones of her diet. Today's Reader Kada Fehlman is an Internal Medicine Resident at Huntington Health Cedars-Sinai. About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. More from Dr. Raj ⁠⁠⁠The Dr. Raj Podcast⁠⁠⁠ ⁠⁠⁠Dr. Raj on Twitter⁠⁠⁠ ⁠⁠⁠Dr. Raj on Instagram⁠⁠⁠ Want more board review content? ⁠⁠⁠USMLE Step 1 Ad-Free Bundle⁠⁠⁠ ⁠⁠⁠Crush Step 1⁠⁠⁠ ⁠⁠⁠Step 2 Secrets⁠⁠⁠ ⁠⁠⁠Beyond the Pearls⁠⁠⁠ ⁠⁠⁠The Dr. Raj Podcast⁠⁠⁠ ⁠⁠⁠Beyond the Pearls Premium⁠⁠⁠ ⁠⁠⁠USMLE Step 3 Review⁠⁠⁠ ⁠⁠⁠MedPrepTGo Step 1 Questions⁠⁠⁠ ⁠⁠⁠MedPrepTGo Step 2 Questions⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Mike, Debi, Nathan and Ashley Pearl answer questions sent in from viewers.

Pastor Levi and Lisa talk about how God is near, seeks worshippers, and wants to be found, including when God feels distant, God finds us in lowly places, how we move toward God. This is an episode of Pearls & Swine on the Evangel Houghton Podcast from Evangel Community Church, Houghton, Michigan, December 9, 2025.

What if the holidays could feel spacious, nourishing, and connected? This episode offers a strengths-based perspective on holiday dynamics—focusing less on what goes wrong and more on the mindful choices that cultivate ease, joy, and connection, even amidst grief, change, and complexity. We share what helped us experience Thanksgiving with ease this year.  Our experiences were quite different, and yet a shared approach grounded in intention, space, simplicity, and trust led to remarkably peaceful gatherings. Whether you're anticipating difficult family moments, feeling the ache of absence, or simply longing for more presence, we hope this conversation brings clarity and peace. Pearls of Wisdom: Speaking early and clearly about what matters shifts the energy of gatherings. Grief and joy can coexist—and allowing grief makes more room for peace. Space (mental, emotional, physical) supports nervous system regulation and connection. Letting go of rigid plans often makes things flow better. Flexibility and boundaries are both acts of love. Reflection Questions: What would a spacious, easeful holiday look like for you? What expectations are you willing to soften or let go? Where might more trust, flexibility, or rest make a difference? If this episode resonated… We invite you to take this work deeper.  Coaching with me offers personalized support to create space, peace, and purpose in your life—through the holidays and far beyond. Learn more here: https://www.jessiemahoneymd.com/coaching For a truly transformative experience, consider joining me on retreat in 2025: www.jessiemahoneymd.com/retreats Nothing shared in the Healing Medicine Podcast is medical advice.  

Lucretia hosts this week's episode with the running theme that there's too much pearl clutching going on among the hand-wringers in Washington and the media. We flop our pearls of wisdom on the Tennessee special election, the J6 bomber arrest, the double-tap bombings on Venezuelan "fishing boats," the Minnesota welfare scandal, and the related immigration control issues it raises. We have some diversions into the latest Trumpian nomenclature, including his rehabilitation of "third world countries" and the "R-word," as Minnesota Gov. Tim Walz calls it, and how Sydney Sweeney might react to listening to an episode of the 3WHH (because it is the new Kantian Categorical Imperative that Sydney Sweeney must be kept in the news).Exit music this week is “Clutchin' Pearls,” by Ross Kleiner and the Thrill. Key lyric that does not apply to our hostess with the mostest: “She's so mad/I left her clutchin' pearls!”

In this episode, the CardioNerds (Dr. Naima Maqsood, Dr. Akiva Rosenzveig, and Dr. Colin Blumenthal) are joined by renowned educator in electrophysiology, Dr. Joshua Cooper, to discuss everything atrial flutter; from anatomy and pathophysiology to diagnosis and management. Dr. Cooper's expert teaching comes through as Dr. Cooper vividly describes atrial anatomy to provide the foundational understanding to be able to understand why management of atrial flutter is unique from atrial fibrillation despite their every intertwined relationship. A foundational episode for learners to understand atrial flutter as well as numerous concepts in electrophysiology. Audio editing for this episode was performed by CardioNerds intern Dr. Bhavya Shah.  CardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls "The biggest mistake is failure to diagnose”. Atrial flutter, especially with 2:1 conduction, is commonly missed in both inpatient and outpatient settings so look carefully at that 12-lead EKG so you can mitigate the stroke and tachycardia induced cardiomyopathy risk  Decremental conduction of the AV node makes it more challenging to rate control atrial flutter than atrial fibrillation  Catheter Ablation is the first line treatment for atrial flutter and is highly successful, but cardioversion can be utilized as well prior to pursuing ablation in some cases.  Class I AADs like propafenone and flecainide may stability the atrial flutter circuit by slowing conduction and thus may worsen the arrhythmia. Therefore, the preferred anti-arrhythmic medication in atrial flutter are class III agents.  Atrial flutter can be triggered by firing from the left side of the heart, so in patients with both atrial fibrillation and flutter, ablating atrial fibrillation makes atrial flutter less likely to recur.  BONUS PEARL: Dr. Cooper's youtube video on atrial flutter is a MUST SEE!  Notes Notes: Notes drafted by Dr. Akiva Rosenzveig  What are the distinguishing features of atrial fibrillation and flutter?  Atrial flutter is an organized rhythm characterized by a wavefront that continuously travels around the same circuit leading to reproducible P-waves on surface EKG as well as a very mathematical and predictable relationship between atrial and ventricular activity  Atrial fibrillation is an ever changing, chaotic rhythm that consists of small local circuits that interplay off each other. Consequently, no two beats are the same and the relationship between the atrial activity and ventricular activity is unpredictable leading to an irregularly irregular rhythm  What are common atrial flutter circuits?  Cavo-tricuspid isthmus (CTI)-dependent atrial flutter is the most common type of flutter. It is characterized by a circuit that circumnavigates the tricuspid valve.  Typical atrial flutter is characterized by the circuit running in a counterclockwise pattern up the septum, from medial to lateral across the right atrial roof, down the lateral wall, and back towards the septum across the floor of the right atrium between the IVC and the inferior margin of the tricuspid valve i.e. the cavo-tricuspid isthmus. Surface EKG will show a gradual downslope in leads II, III, and AvF and a rapid rise at end of each flutter wave.   Atypical CTI-dependent flutter follows the same route but in the opposite direction (clockwise). Therefore, we will see positive flutter waves in the inferior leads   Mitral annular flutter is more commonly seen in atrial fibrillation patients who've been treated with ablation leading to scarring in the left atrium.  Roof-dependent flutter is characterized by a circuit that travels around left atrium circumnavigating a lesion (often from prior ablation), traveling through the left atrial roof, down the posterior wall, and around the pulmonary veins  Surgical/scar/incisional flutter is seen in people with a history of prior cardiac surgery and have iatrogenic scars in right atrium due to cannulation sites or incisions  How does atrial flutter pharmacologic management differ from other atrial arrhythmias?  The atrioventricular (AV) node is unique in that the faster it is stimulated, the longer the refractory period and the slower it conducts. This characteristic is called decremental conduction. In atrial fibrillation, the atrial rate is so fast that the AV node becomes overwhelmed and only lets some of those signals through to the ventricles creating an irregular tachycardia but at lower rates. In atrial flutter, the atrial rate is slower, therefore the AV node has more capability to conduct allowing for higher ventricular rates. Therefore, to achieve rate control one will need a higher dose of AV blocking medications. Atrial tachycardia may require even higher doses due to the increased ability of the AV node to conduct, as the atrial rates are slower than in atrial flutter.  Sodium channel blockers (Class I) such as flecainide and propafenone slow wavefront propagation, making it easier for the AV node to handle the atrial rates. This will end up leading to increased ventricular rates which can be dangerously fast. That is why AV nodal blockers should be used in conjunction with flecainide and propafenone.  What is the role of cardioversion in atrial flutter management?  Due to high success rate with atrial flutter ablation, ablation is the first line treatment. However, sometimes cardioversion may be utilized in patients depending on how symptomatic they are and how long it will take to get an ablation. Cardioversion may also be utilized preferentially when the atrial flutter was triggered by infection or cardiac surgery to see if it will come back.   If cardioversion is pursued, the patient will need to be anticoagulated due to the stroke risk after the procedure due to post-conversion stunning.  How effective is atrial flutter ablation?  The landmark Natale et al study in 2000 demonstrated 80% success rate after radiofrequency ablation as compared to 36% in patients on anti-arrhythmic therapy. The LADIP study in 2006 further corroborated these findings. Contemporary data shows above 90% success rate of atrial flutter ablation.  In patients who have had both atrial fibrillation and atrial flutter, most electrophysiologists would ablate both. However, in patients with atrial fibrillation, the atrial flutter usually is initiated by trigger spots firing in the left atrium. Once the atrial fibrillation is ablated, the flutter will become less likely. Therefore, there are those who say there's no need to ablate the flutter circuit as well. Alternatively, if a patient has severe comorbidities and/or is high risk for ablation, one may consider performing the atrial flutter ablation only since atrial flutter is harder to manage medically compared with atrial fibrillation.   How do you manage atrial flutter in the acute inpatient setting?  In the inpatient setting, electrical cardioversion is often limited by blood pressure and the hypotensive effects of the sedatives required. If one is awake and too hypotensive, chemical cardioversion can be pursued. The most effective anti-arrhythmic for this is ibutilide. Amiodarone is not effective for acute cardioversion. Since ibutilide prolongs refractoriness in atrial and ventricular tissue, there's a risk of long QT induced torsades de pointes. Pretreating with magneisum reduces the risk to 1-2%.  References Jolly WA, Ritchie WT. Auricular flutter and fibrillation. 1911. Ann Noninvasive Electrocardiol. 2003;8(1):92-96. doi:10.1046/j.1542-474x.2003.08114.x  McMichael J. History of atrial fibrillation 1628-1819 Harvey - de Senac - Laënnec. Br Heart J. 1982;48(3):193-197. doi:10.1136/hrt.48.3.193  Lee KW, Yang Y, Scheinman MM; University of Califoirnia-San Francisco, San Francisco, CA, USA. Atrial flutter: a review of its history, mechanisms, clinical features, and current therapy. Curr Probl Cardiol. 2005;30(3):121-167. doi:10.1016/j.cpcardiol.200  2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1):e167. doi:10.1161/  Cosío F. G. (2017). Atrial Flutter, Typical and Atypical: A Review. Arrhythmia & electrophysiology review, 6(2), 55–62. https://doi.org/10.15420/aer.2017.5.2  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-11/Atrial-flutter-common-and-main-atypical-forms Natale A, Newby KH, Pisanó E, et al. Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. J Am Coll Cardiol. 2000;35(7):1898-1904. doi:10.1016/s0735-1097(00)00635-5  Da Costa A, Thévenin J, Roche F, et al. Results from the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP) trial on atrial flutter, a multicentric prospective randomized study comparing amiodarone and radiofrequency ablation after the first episode of symptomatic atrial flutter. Circulation. 2006;114(16):1676-1681. doi:10.1161/CIRCULATIONAHA.106.638395  https://www.acc.org/Membership/Sections-and-Councils/Fellows-in-Training-Section/Section-Updates/2015/12/15/16/58/Atrial-Fibrillation#:~:text=The%20first%20'modern%20day'%20account,in%20open%20chest%20animal%20models.&text=In%201775%2C%20William%20Withering%20first,(purple%20foxglove)%20in%20AFib.

A listener writes in asking how to handle the pressure of their final official LSAT attempt. Ben and Nathan remind them that their highest score on record, a 165, is already strong enough for full scholarships at many law schools. They encourage the listener to let go of perfectionism, be comfortable with not finishing a section, and approach test day expecting  incremental improvement.Also in this episode:- An update on an LSAC cheating allegation- Ben and Nathan react to the ABA lifting its probation of Cooley Law- Advice from Demon students who recently crushed the LSATStudy with our Free Plan⁠⁠Download our iOS app⁠Watch Episode 535 on YouTubeCheck out all of our “What's the Deal With” segmentsGet caught up with our ⁠Word of the Week⁠⁠ library0:00 Update on Cheating Allegations5:24 ABA Lifts Probation for Cooley10:50 How to Approach Your Last Official Attempt21:44 Tips from Departing Demons34:25 Chances at a T14 as a Super kJD41:10 Pearls vs. Turds43:27 Personal Statement Gong Show57:12 Word of the Week — Percolation