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On this episode of The Wholesome Fertility Podcast, I am joined by Dr. Nirali Jain (eggspert_md), a board-certified OB/GYN and reproductive endocrinologist at Reproductive Medical Associates (RMA). Dr. Jain shares her expert insights on fertility preservation for individuals undergoing cancer treatment, a crucial yet often overlooked aspect of reproductive care. We explore what options are available for fertility preservation, including egg and sperm freezing, and why it's so important to initiate these discussions before starting chemotherapy or radiation. Dr. Jain also explains the difference between Letrozole and Clomid, the impact of estrogen-sensitive cancers on IVF treatments, and innovative approaches like random-start cycles and DuoStim protocols. Whether you're facing a cancer diagnosis or simply thinking proactively about your reproductive future, this conversation is filled with knowledge and reassurance. Key Takeaways: Why it's essential to discuss fertility before starting cancer treatment. The role of Letrozole in estrogen-sensitive cancers and fertility preservation. Differences between Letrozole and Clomid, and why Letrozole is often preferred. How new protocols like DuoStim and random-start cycles are improving outcomes. Why fertility preservation is important even for those without a cancer diagnosis. Guest Bio: Dr. Nirali Jain (@eggspert_md) is a board-certified OB/GYN and fertility specialist at Reproductive Medicine Associates (RMA) in Basking Ridge, New Jersey. She earned both her undergraduate degree in neurobiology (with a minor in dance!) and her medical degree from Northwestern University, before completing her residency at Weill Cornell/NYP, where she served as co-Chief Resident, and her fellowship in reproductive endocrinology and infertility at NYU Langone. Deeply passionate about women's health and fertility preservation, Dr. Jain blends the latest research and cutting-edge treatments with compassionate, patient-centered care. Her interests include third-party reproduction and oncofertility, and she is especially passionate about supporting patients navigating fertility preservation through a cancer diagnosis. Outside of the clinic, Dr. Jain is a trained dancer, a dedicated global traveler, and an adventurer working toward hiking all seven continents with her husband. Her diverse experiences, from international medical rotations to personal connections with friends and family navigating infertility, have shaped her into a warm, resourceful, and determined advocate for her patients. Links and Resources: Visit RMA websiteFollow Dr. Nirali Jain on Instagram For more information about Michelle, visit www.michelleoravitz.com To learn more about ancient wisdom and fertility, you can get Michelle's book at: https://www.michelleoravitz.com/thewayoffertility The Wholesome Fertility facebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/ Instagram: @thewholesomelotusfertility Facebook: https://www.facebook.com/thewholesomelotus/ Disclaimer: The information shared on this podcast is for educational and informational purposes only and is not intended as medical advice. Please consult with your healthcare provider before making any changes to your health or fertility care. --  Transcript:   # TWF-Jain-Nirali (Video) ​[00:00:00]  **Michelle Oravitz:** Welcome to the podcast Jain.  **Dr. Nirali Jain:** Thanks so much for having me **Michelle Oravitz:** Yeah, so. **Michelle Oravitz:** I'm very excited to talk about this topic, which, um, actually you don't really hear a lot of people talking about, which is how to preserve your fertility if you're going through a cancer diagnosis and if you have to go through treatments. 'cause obviously that can impact a lot on fertility. **Michelle Oravitz:** I have, um, seen actually like a colleague of mine go through. And she also preserved her fertility and, and now she has a baby boy. so it's really nice. **Michelle Oravitz:** to **riverside_nirali_jain_raw-video-cfr_michelle_oravitz's _0181:** so nice. **Michelle Oravitz:** So I'd love for you first to introduce yourself and kind Of give us a background on how you got into this work. **Dr. Nirali Jain:** Of course. Um, so I am Dr. Narly Jane. I am, um, an OB GYN by training, and then I did an additional, after completing four years of residency in OB GYN and getting board certified in that, I did an additional training in reproductive endocrinology and [00:01:00] infertility or otherwise known as REI. So now I'm a fertility specialist. **Dr. Nirali Jain:** Um, I trained at Northwestern in Chicago, so I went to undergrad and medical school there. And then, um, home has always been New Jersey for me, so I moved back out east to New Jersey. Um, I did all my training actually in New York City at Cornell for residency and NYU for fellowship. Um, and then moved to the suburbs. **Dr. Nirali Jain:** Um, and now I'm a fertility specialist in, in Basking Ridge at Reproductive Medical Associates.  **Michelle Oravitz:** Very impressive background. That's awesome.  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** I'd love to hear just really. About what your process is. If a person has been diagnosed with cancer, like what is the process? What are some of the things that you address if they are trying to preserve fertility, and what are some of the concerns going  **Dr. Nirali Jain:** yeah, yeah. All great questions. So, you know, there's a lot of us, uh, the Reis. Are a very small, [00:02:00] there's a very small number of us. So in terms of specializing in fertility preservation, technically we all are certified to treat patients with cancer and kind of move them through fertility preservation before starting chemotherapy. **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** Um, luckily we've been working closely with oncologists in the past several years just to establish some type of streamlined system because having a diagnosis of cancer and hearing all that information. Especially when you're young is so hard. So I think that's, that's where my interest started in terms of being able to speak to and counsel cancer patients. **Dr. Nirali Jain:** I think it is a very specific niche that you really have to be comfortable with in our field. Um, I. So I'll kind of walk you through, you know, what it, what does it look like, right? Um, you go into your oncologist's office suspecting that you have this, this lump. I'll take breast cancer, for example. It could really be any kind of cancer. **Dr. Nirali Jain:** Um, but breast cancer in a reproductive age patient or someone that's in those years where you're starting [00:03:00] to think about building a family, planning a family, um, or if you have kids at home, that's usually the type of patient that we see come in with a breast cancer diagnosis. So. Kinda just taking that, for example, um, the minute that you're diagnosed, it's really your oncologist's responsibility to counsel you on what treatment options are going to be offered to you. **Dr. Nirali Jain:** And then based off of the treatment options, it's important to know how that affects your reproduction. So how does it affect your ovaries in the short term, in the long term, um, in any way possible. So. Once a patient is initially referred from their oncologist to myself or any other fertility specialist, they come into my office and we just have a 30 minute conversation really talking about family planning goals. **Dr. Nirali Jain:** Any kids that they've had in the past either naturally conceived or through um, IVF, and then we talk about where they're at in their relationship. Are they married, are they not? Are they with a partner, [00:04:00] a male partner, a female partner, whatever it might be. It's important to know the social standpoint, um, especially in this sensitive phase of life. **Dr. Nirali Jain:** So patient patients usually spend anywhere from 30 minutes to an hour. Um, just kind of talking through where they're at, how they're feeling, what their ultimate childbearing goals are. And then from there we do an ultrasound and that's when I'm really able to see, you know, the, the reproductive status. **Dr. Nirali Jain:** So what do the ovaries look like? What does the uterus look like? Is there something that I need to be concerned about from a baseline GYN standpoint? Um, and all of those conversations are happening in real time. So. I think one of the things is patients come in and they're like, I'm already so overwhelmed with all this information from my oncologist, and now my fertility specialist is throwing all this information at me. **Dr. Nirali Jain:** Luckily, the way I like to frame it is you come in and you just let go. Like you let us do the work because in the background we're the ones talking to your oncologist. We're the [00:05:00] ones giving that feedback and creating a timeline with your oncologist. Um, and really I think just getting in the door is the hardest part. **Dr. Nirali Jain:** So once patients are here to see us, we go through the whole workup. We do anything that we would do for a normal patient that came in for fertility preservation. And then based off of where they're at in their journey, we talk about what makes sense for them, whether that means freezing embryos, freezing eggs, they're very similar in terms of the, the few weeks leading up to the egg retrievals. **Dr. Nirali Jain:** So I have that whole conversation just at the initial visit. And then from there we talk about the timeline behind the scenes and make sure that it works with their lives before moving forward. **Michelle Oravitz:** So for people listening to this, why, and this might be an obvious question, but to some it might not be,  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** why would somebody want to preserve. eggs or sperm. 'cause I've had actually some couples  **Dr. Nirali Jain:** Yep. **Michelle Oravitz:** come to me where the husband preserved the sperm and they had to go through IVF just because he was going [00:06:00] through cancer treatments. So he had to preserve the sperm ahead of time.  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** people need to consider doing that before doing cancer treatments?  **Dr. Nirali Jain:** So there are certain cancer treatments that do affect the ovaries and the sperm health, and you know, for men and women, it affects your reproductive organs. In a similar way, um, depending on the type of chemotherapeutic agent, there are some that are more dangerous in terms of, um, being toxic to your ovaries or toxic to your sperm. **Dr. Nirali Jain:** And those are the instances where we are really thinking about what's the long-term impact because there's medications that oncologists do give patients, and our oncologists are amazing, the ones that we work with, Memorial Sloan Kettering from Reproductive Medical Associates through RMA, um, and. **Dr. Nirali Jain:** They're just so good at what they do and are so well-trained, so they know in the back of their mind, is this going to impact your ovaries or your sperm health or not? Um, and I [00:07:00] think that any chemotherapy, you know, your ovaries are these, these small organs that are constantly turning over follicles every month. **Dr. Nirali Jain:** So every month we're losing those eggs, and if they don't become. If an egg isn't ovulated, it doesn't become a baby, it's just gonna die off. So I counsel even patients that don't have cancer, I counsel them on fertility preservation as young as possible. You know, between the ages of 28 and 35, that's like the best time to preserve your fertility. **Dr. Nirali Jain:** So in cancer patients, there's an extra level added to that where even if they are a little bit younger, a little bit older. Your eggs are not gonna be the same quality. There's gonna be higher level of chromosomal errors, more DNA breakage, um, and, and bigger issues that lead to issues with conceiving naturally afterwards. **Dr. Nirali Jain:** So I think that it's important to consider how that chemotherapy is going to affect them or how surgery would affect them if it was, for example, a GYN cancer where [00:08:00] we're removing a whole ovary, you know, what, what do we have to do to preserve your fertility in that case? And those are important conversations to have. **Michelle Oravitz:** Yeah. for sure. I know that a lot of people are also concerned, you know, with going through the IVF process, you're taking in a lot of estrogen, a lot of hormones, and many cancers are actually estrogen sensitive. So I wanted to talk to you about that. 'cause I know that the data shows that it's. It's been fine, which some people might find surprising, but I wanted you to address that and just kind of **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** from your perspective.  **Dr. Nirali Jain:** That's so interesting that you asked that question because I actually, my whole I I graduated fellowship last year and my entire, like passion project in fellowship was looking at one of the drugs that we use to suppress the estrogen levels specifically in cancer patients. Um, and I had presented this at a few of our reproductive meetings. **Dr. Nirali Jain:** Um, A SRM is one of our annual meetings where all of the reiss get together. A lot of male fertility [00:09:00] specialists come and we kinda just talk about. Specific things and fertility preservation for cancer patients is, has been an ongoing topic of interest for all of us. Um, and it's important to know that there are different medications that we can offer. **Dr. Nirali Jain:** Letrozole is the one that I, um, have a particular love for and I, uh, you know, I use all the time for my patients, um, for different reasons, but it suppresses the exposure that your body has to estrogen. And there's mixed data, um, out there in terms of, you know, does Letrozole suppression actually impact, you know, does it help or. **Dr. Nirali Jain:** Or does it have no impact on your future risk of cancer after treatment? Um, and that honestly is still up for debate. But what we do know is that there's no increased risk of cancer recurrence in patients that have undergone fertility preservation with or without Letrozole. Um, Letrozole is one of those things that we can give, and the way it works is basically. **Dr. Nirali Jain:** It masks that [00:10:00] conversion. It, it doesn't allow for conversion from those androgens in the male hormones over to estrogen. Um, and so your body doesn't really see that estrogen exposure. It stays nice and low throughout your cycle, and it does help with actually ovarian maturation and getting mature eggs harvested and, um, helps a little bit with, with quality too. **Dr. Nirali Jain:** So I think that it's really nice in terms of having that available to us, but know that. It's not, it's not essential that you have it, really, the data showing plus minus. Um, but there are certain things that we can do to protect the ovaries, protect your exposure to estrogen. Um, and so that shouldn't be top of mind of concern when we're going through fertility preservation, even with an estrogen sensitive cancer. **Michelle Oravitz:** Actually, so, uh, on a different topic, kind of going back to that, so Letrozole versus Clomid, I, it's like a, the questions I personally feel just based on what I've heard and like my own research that Letrozole would be kind of like the more. [00:11:00] Um, the, it's, it's a little better, but I know that it really depends on the person as well.  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** they might do better with Clom, but I'd love to hear your perspective and kind of pick your brain on this.  **Dr. Nirali Jain:** totally. You're choosing all the, all the right questions because these are all of my, my specific interests and niches. So  **Michelle Oravitz:** Oh,  **Dr. Nirali Jain:** Letrozole is basically, you know, we use Letrozole and Clomid in. Patients that don't have cancer and patients that come in for an intrauterine insemination, that's kind of the most common scenario where we're thinking about, you know, which medication is better? **Dr. Nirali Jain:** Letrozole or Clomid and Clomid used to be the, the most common medication that we use, we dose patients, you know, have 50 milligrams of Clomid, give them five days of the medication. It's an oral pill. Feels really easy and. The way it works is really, it recruits more than one follicle, so it really helps with the release of, um, more than one follicle growing more than one follicle in the ovary. **Dr. Nirali Jain:** Um, but it has a little bit [00:12:00] higher of a risk of twins because that's exactly what it's good at. Um, Clomid, not so much in the cancer. In the cancer front, it's not really used there because it's considered, from a scientific perspective, it's considered like a selective estrogen receptor modulator. So it doesn't necessarily suppress your estrogen levels in the same way that Letrozole does versus. **Dr. Nirali Jain:** Letrozole is an aromatase inhibitor, so it really blocks the chemical conversion of one drug or one hormone to the other hormone. Um, the reason we love Letrozole so much, and I don't mean to like gush over Letrozole, but um, it's a mono follicular agent, so it works really well at recruiting one follicle  **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** you know, every OB-GYN's nightmare in a way is having multiples when you didn't intend on having multiples at all. **Michelle Oravitz:** so  **Dr. Nirali Jain:** Um. **Michelle Oravitz:** were saying that, um, there's more of a chance of twins, it's Clomid, not letrozole.  **Dr. Nirali Jain:** Yes, there's a higher chance with Clomid versus Letrozole. And I mean, don't get me wrong, there's a chance of twins with [00:13:00] any type of assisted reproductive technology. Even when we're doing single embryo transfers, there's a chance that it's gonna split. So, um, the chance is always there just like it is in the natural world. **Dr. Nirali Jain:** But we know for a fact that. CLO is really good at recruiting many follicles. It's good for certain patients that don't respond well to Letrozole. Um, but Letrozole is kind of our, our go-to drug these days just because of all the benefits that we've seen.  **Michelle Oravitz:** Awesome.  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** These are all fun things to ask because I, I love talking to our eis 'cause there's so much information that I'm always  **Dr. Nirali Jain:** totally. **Michelle Oravitz:** learn a lot from my patients in my own research, but it's really cool. Picking your guys' brains. So another question I have, and I have actually talked to Dr. Andrea Elli, he's been on,  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** and he does a lot of endometriosis and, and immune related work as well,  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** so. I'd love to know just from your perspective. One thing that I do know from, based on what I've heard is that the, [00:14:00] guess like you were just saying, that breast cancer or estrogen sensitive breast cancer doesn't seem to be affected by IVF cycles, however, and endometriosis lesions do get affected.  **Dr. Nirali Jain:** Yeah. **Dr. Nirali Jain:** that's a great question. So, you know, every, there are so many complex G mind diagnoses that the, that our patients come in with. Um, and endometriosis is a big one because there is clear data that endometriosis is linked to infertility. So we think about, you know, when a patient comes in with endometriosis, we really do think about the different treatment options and what are the short-term and long-term impacts of the hormones that we're giving 'em. **Dr. Nirali Jain:** Um, these days, again, kind of going back to Letrozole, we, letrozole is something that I give all of my endometriosis patients because it helps suppress their estrogen because we know.  **Michelle Oravitz:** interesting.  **Dr. Nirali Jain:** is very responsive to estrogen and leads to this dysfunctional regulation of all the endometrial tissue that can really flare in a, [00:15:00] in a cycle, or shortly after a cycle. **Dr. Nirali Jain:** I. So we really, for endometriosis patients, the, the best treatment is being on birth control because we don't see that hormonal fluctuation. The up and down of the estrogen and the progesterone, that's what leads to those flares. Um, so I really, I watch patients closely after their cycles too, because you definitely can have an endometriosis flare and we say the best treatment for endometriosis is pregnancy, right? **Dr. Nirali Jain:** That's when you're suppressed, that's when you're at your lowest. Um, and patients, my endo patients feel so good in pregnancy because they have. Hormones that are nice in that baseline, they're not getting periods of course. Um, and that's truly, truly the best treatment.  **Michelle Oravitz:** That's interesting.  **Dr. Nirali Jain:** But it is important to consider when you're going through infertility treatments. **Dr. Nirali Jain:** How does my endometriosis affect the short and long-term effects of the fertility medications? And really not to, not to say that they're bad in any way. I think a lot of endometriosis patients go through IVF and have success and do really, really well, and that's kind of the push that they need. [00:16:00] Um, but it's important to be mindful of the bigger picture here. **Dr. Nirali Jain:** It's not just, you're not just a number of. A patient with endo coming in, getting the same protocol. It's really individualized to the extent of your lesions, what symptoms you're having, what grade of endometriosis, where your lesions are. So we're the RAs are thinking about everything before we actually start your protocol. **Michelle Oravitz:** It's crazy how in depth it is, and it's, it, there's just so, it's so multifaceted,  **Dr. Nirali Jain:** Yeah,  **Michelle Oravitz:** when it's females  **Dr. Nirali Jain:** totally. **Michelle Oravitz:** are a little, I mean, they can, you know, there, there's definitely a number of things, but it's not as complicated and interconnected  **Dr. Nirali Jain:** Exactly. Exactly. That's so true. **Michelle Oravitz:** And so one question I actually have, this is kind of really off topic, but something that I was curious about. **Michelle Oravitz:** 'cause I heard about a while  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** a, a type of cancer treatment that was used. I'm not sure exactly what it was, but for some reason it actually caused follicles to grow, [00:17:00] or to multiply. And they were **Dr. Nirali Jain:** Interesting. **Michelle Oravitz:** this definitely. Puts, um, the whole idea of like a woman being born with all the follicles she'll ever have on its head, I thought that was really Interesting. **Michelle Oravitz:** Now I learned a little bit about it. I don't think it really went further than that,  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** one of those things that they're like, Hmm, this is interesting. I don't know, it was kind of a random side effect of this chemo drug. I dunno if it was a chemo drug or a cancer drug.  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** ever heard of that. **Michelle Oravitz:** So I was just **Dr. Nirali Jain:** I haven't, I mean, that's interesting. I feel like I'd have to look into that because that would be definitely a point of interest for a lot of Reis. But it kind of does go back to the point of, you know, women are really born with all the eggs we're ever gonna have. So it's about a million, and then it just goes down from there. **Dr. Nirali Jain:** And the, by the time you start having periods, I like to kind of show my patients a chart, but you have a couple hundred thousand eggs and you ovulate one egg a month. That's, you know. Able to [00:18:00] progress into a fertilized egg and then into a, an embryo into a baby, um, if that's your goal. But otherwise, patients that are having periods and not trying to actually get pregnant, we're losing hundreds of eggs a month. **Dr. Nirali Jain:** So.  **Michelle Oravitz:** Mm.  **Dr. Nirali Jain:** It's important to kind of think about that decline, and it's important to know that that rate can be faster in patients with cancer, patients with low ovarian reserve. And sometimes when you have the two compounded, that's when a fertility specialist is definitely, you know, in the queue to, to have a discussion with you in terms of what that means and how you can reach your family building goals despite being faced with that, with that challenge. **Michelle Oravitz:** Yeah. **Michelle Oravitz:** I mean, 'cause we know oxidative stress is one of the things that can cause, uh,  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** quality eggs, but it's also can cause cancer. **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** um, similar, you know, like things that really deplete the body could definitely impact. Um, and then what are your thoughts? I know I'm asking you all kinds of random questions, **Dr. Nirali Jain:** I love it. **Michelle Oravitz:** are your thoughts about doing low simulation in certain [00:19:00] circumstances versus high stem? **Michelle Oravitz:** Sometimes people don't respond as well to higher stems.  **Dr. Nirali Jain:** Yeah, that's a great point. I think that it kind of all goes back to creating an individualized protocol. If. A patient's going to a practice and basically just getting a protocol saying, this is our standard. We start with our standard of, you know, I, I think about the standard, which is 300 of the FSH or that pen that you dial up, and then 150 units of that powder vial. **Dr. Nirali Jain:** And we have patients mixing powders all the time, and that's kind of our blanket protocol that we give patients. But that's not really what's happening behind the scenes. And if you're given a protocol that's, and being told, you know, this is kind of what we give to everyone, it's probably not the right fit for you. **Michelle Oravitz:** Yeah, I  **Dr. Nirali Jain:** Um, there are certain patients that respond to a much lower dose and do really, really well, and then some patients that need a much higher dose. Um, and I think it's, that's kind of like the fun part of being an REI of being able to individualize the [00:20:00] protocol to the patient. Um, and I know for a fact there are so many, luckily, you know, we have so many leaders in REI that have been. **Dr. Nirali Jain:** Have dedicated their entire careers to researching these different protocols and how they can help different patients. Um, patients with lower a MH, you know, might benefit from a duo stim protocol, for example. That's kind of the first one that comes to mind, but a protocol where we're using those follicles from the second half of a cycle. **Dr. Nirali Jain:** I would've never thought that those were the follicles that  **Michelle Oravitz:** Oh,  **Dr. Nirali Jain:** would be better than the first half of the cycle,  **Michelle Oravitz:** Wait,  **Dr. Nirali Jain:** but, **Michelle Oravitz:** that. Explain that. Um, because I think that that's kind of a unique  **Dr. Nirali Jain:** mm-hmm.  **Michelle Oravitz:** that I haven't heard of.  **Dr. Nirali Jain:** Yeah, so there's this new day. It's still kind of developing, but um, kind of going back to, you know, what's an individualized protocol? Duo STEM is one of the newer protocols that we've started using. I, I've used it once or twice in patients. Um, but it goes back to the research that shows that you might actually have two different periods of time in a menstrual cycle where you could potentially recruit [00:21:00] follicles. **Dr. Nirali Jain:** You could have a follicular phase where there's a certain cohort of follicles recruited, and then you have a follicle that forms creates a corpus glut.  **Michelle Oravitz:** um, protocols  **Dr. Nirali Jain:** Yep. And then you basically go through the follicular protocol and then a few days after a retrieval, instead of waiting for a new follicular cohort or follicular recruitment from the first half of your menstrual cycle, you actually use the luteal phase and you recruit those follicles that would've actually died off or have been prematurely recruited in a prior cycle. **Dr. Nirali Jain:** So **Michelle Oravitz:** that's So  **Dr. Nirali Jain:** yeah, **Michelle Oravitz:** you just do a similar, I guess, um, medicine,  **Dr. Nirali Jain:** go right back into it.  **Michelle Oravitz:** do the same exact thing, but right after ovulation.  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** Fascinating. That's really interesting.  **Dr. Nirali Jain:** Yeah,  **Michelle Oravitz:** has been your experience with that?  **Dr. Nirali Jain:** I think it's, honestly, it's mixed. Um, so far, you know, our data from fertility and sterility and A SRM, it, it shows support for these DUO STEM [00:22:00] protocols, saying that if patients don't have that great quality of eggs or if they have a very low number, maybe they'd benefit from starting the meds earlier and recruiting follicles. **Dr. Nirali Jain:** A little bit earlier. Um, so we've seen positive results so far. A lot of work to be done in terms of really understanding it. Um, and of course, as a new attending, I have a lot more experience to kind of build on. Um, but I, I have seen success from it. **Michelle Oravitz:** That's fascinating. Are there any other new technologies, like new add-ons, um, that you've seen, that you've found to be really cool or interesting?  **Dr. Nirali Jain:** I think the biggest thing, actually, kind of going back to our whole topic for today is fertility preservation cancer patients. One of the biggest things that I've learned recently is that we used to start fertility, um, patients. You know, only in the beginning of the cycle days, two or three is technically like when most. **Dr. Nirali Jain:** Most clinics, um, start patients, but for our cancer patients, sometimes you don't have that time. You don't wanna wait a full month to [00:23:00] restart, um, your, you know, your menstrual cycle and then do the fertility preservation and then delay chemotherapy a full month. So we started doing what we call random starts. **Dr. Nirali Jain:** So you basically start a patient whenever they come in. You know, it could be the day after your consultation, the day of your consultation. I've kind of seen all of the above. Um, and we've seen really good success with random starts, per se. Um, and we've been doing a lot more of that, where it's not as dependent on where you're at in your cycle. **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** Um, obviously there's a difference in outcomes. You might not be a great candidate for it, so definitely it's worth talking to your doctor about it. But it kind of gives relief to our cancer patients where if you have a new cancer diagnosis and you're like, oh, I just finished my period, like, I can't even start a cycle until next month. **Dr. Nirali Jain:** That's not always true. Um, so it's always worth it to go into see a fertility specialist and just get, you know, get the data that you need right away, and then you can make a decision later on. **Michelle Oravitz:** For sure. Um, Yeah. **Michelle Oravitz:** and I wanted to kind of cover a lot of different topics 'cause I know that [00:24:00] some people are gonna wanna hear what you have to say that don't necessarily, or, uh, have cancer. But it is important. I, I think that, you know, if you get to thirties and you haven't gotten married or you don't have a partner, I think it's really important to preserve your fertility in general.  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** important thing. And then if you were going through a cancer diagnosis and you decided to preserve your fertility, um, guess more for women because they're eventually going to be thinking about transfers after they go through treatment. So what are some of the things that they would need to consider as far as that goes? **Michelle Oravitz:** Like after the  **Dr. Nirali Jain:** yeah, **Michelle Oravitz:** then they go through the cancer treatments. Um, and then what, how long should they  **Dr. Nirali Jain:** yeah. Like what does it look like? So I've had patients that come back, you know, in my fellowship training I did a, a couple research projects on patients that came back to pursue an embryo transfer, um, after chemotherapy agent. And basically compared them to how they did, um, [00:25:00] compared to patients that didn't have cancer and just froze their embryos or froze their eggs and then came back to pursue a transfer and. **Dr. Nirali Jain:** I think the, the most reassuring thing from the preliminary data that we have is saying that there's no difference in pregnancy rates and no difference in life birth,  **Michelle Oravitz:** Awesome.  **Dr. Nirali Jain:** of whether they had chemotherapy or not. After freezing those eggs and going through fertility preservation.  **Michelle Oravitz:** Amazing.  **Dr. Nirali Jain:** Um, in terms of where your body needs to be, I think the oncologist, we, we wait for their green light. **Dr. Nirali Jain:** We wait for their signal to say, you know, she's safe to carry a pregnancy.  **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** And then once we do that, we basically treat you like any other patient. So if you're coming in for a cycle, if you're having periods, then it's reasonable to try a natural cycle protocol, wait for your body to naturally ovulate an egg. **Dr. Nirali Jain:** And instead of obviously hoping that egg will fertilize, we, um, use a corpus luteum. We use the progesterone from the corpus luteum to really support this embryo being implanted into the uterus. Um. Yeah. [00:26:00] And then there's also another side. I mean, some patients don't get their periods back and they always ask like, what if I never get my period back? **Dr. Nirali Jain:** What if I'm just like in menopause because of the chemotherapy agents? And for that, we can start you on a synthetic protocol or basically an estrogen dependent protocol where you take an estrogen pill for a certain number of days. We monitor your lining, then we start progesterone, um, to support your hormones from that perspective instead of relying on your ovaries to release the progesterone that they need, um, and then doing the embryo transfer a few, few days after progesterone starts. **Dr. Nirali Jain:** So there's definitely different protocols depending on where your menstrual health is at after the chemotherapy or after the cancer treatment. Um, but it's important to kind of just know that. That there's options. It doesn't mean that it's the end of the road if you all of a sudden stop getting your period. **Michelle Oravitz:** Yeah, for sure. I mean, 'cause you, technically speaking, you can really control a lot of that. More so for transfers  **Dr. Nirali Jain:** Yep. **Michelle Oravitz:** Retrievals really is kind of like what [00:27:00] eggs you have, what the quality is. But people can be in complete menopause and you guys can still control their cycles for transfer, which is kind of. A huge difference  **Dr. Nirali Jain:** Yeah,  **Michelle Oravitz:** in the  **Dr. Nirali Jain:** exactly. That's exactly right. Yeah. **Michelle Oravitz:** interesting. Any other, um, new, new things that you're, you guys are excited about? I always like to hear about like the new and upcoming things  **Dr. Nirali Jain:** Of course.  **Michelle Oravitz:** actually before, which I thought was fascinating. Yeah.  **Dr. Nirali Jain:** I feel like there's always like updates and, and new data and things like that coming out, but just know, I think it's important for patients to know, like we're constantly, we're, the reason I chose to even pursue this field was because it's new. Right. There's something that we are discovering every day, every year, and that's what makes our, our conferences so important to attend, um, to really just stay up to date. **Dr. Nirali Jain:** Um, but we are, uh, constantly updating our embryology standards, the way we thaw our eggs, and the success rate associated with a thaw and [00:28:00] how we treat our embryos and the media that we use, right? Like, so we're really thinking about the basic science perspective every single day, and that's what makes this field so unique. **Michelle Oravitz:** It is really awesome. And so do you guys specialize specifically on, um. Egg freezing and, and I mean specific fertility preservation in patients that do that have cancer that are going through treatments, do you guys specialize specifically in that? I mean, I know you do range  **Dr. Nirali Jain:** Yeah. Yeah, because it's such a small community, we all have our own niches and we all kind of have our own interests and  **Michelle Oravitz:** Yeah.  **Dr. Nirali Jain:** no like specific training. There are a couple courses that you take that I took in in training as well, just to kind of understand what it sounds like to, I. Council of fertility preservation, patient with and without cancer. **Dr. Nirali Jain:** Um, and then, you know, you kind of just learn by experience and you form a niche for something that you're passionate about. 'cause that's what makes you, you know, really thorough in, in your treatment. [00:29:00] So that's one of my interests. Um, and, but I would say,  **Michelle Oravitz:** training for that. It's just like  **Dr. Nirali Jain:** yeah, **Michelle Oravitz:** just know how to treat that in  **Dr. Nirali Jain:** exactly.  **Michelle Oravitz:** especially if you're interested in doing that.  **Dr. Nirali Jain:** Exactly. That's exactly right. It's kind of, it just comes with the experience comes with your mentors and who you're surrounded by, and everyone kind of helps each other get to that point. But there are several specialists in our practice at RMA that specialize specifically in fertility preservation in cancer patients. **Dr. Nirali Jain:** So we have a close communication with our oncologist and they know who to refer to within the practice because everyone has their own little interests.  **Michelle Oravitz:** Amazing.  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** Um, definitely. I, like I said, I really enjoy picking your brain because it's a lot of fun for me. I, I do  **Dr. Nirali Jain:** Totally.  **Michelle Oravitz:** acupuncture, so  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** and I, I think that it's just so crazy that our fields don't work together. I mean, we kind of do, but I think, I just feel like it would be so great  **Dr. Nirali Jain:** exactly.[00:30:00]  **Michelle Oravitz:** the expertise because you guys have immense. Benefits like in, in, uh, technology and incredible innovations and, and then the natural aspect of really understanding the, the body. And I, I just think that it would work so amazing together if it was more of like a thing. 'cause it, I know in China they actually combine the two  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** eastern.  **Dr. Nirali Jain:** Yeah, I mean I think that that's so important and there is data that shows, you know, there's actually a recent study that came out just a few weeks ago on the benefits of acupuncture for fertility patients. And we know that, I mean, I recommend it to all of my patients, specifically the day of the embryo transfer. **Dr. Nirali Jain:** We, luckily, we offer it on site at RMA and we have acupuncturists that come in and, and do a session before and after the embryo transfer, and I think. A lot of that is targeted towards stress relief. But I also think that holistically it's important to feel at your best when we're doing something that's so crucial to your, to your health. **Dr. Nirali Jain:** So to really focus on the diet, focus on stress relief, [00:31:00] focus on meditation, yoga, whatever it takes to get to your best wellbeing when you're going through fertility treatments, um, is so important. So I appreciate  **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** like you that really specialize in the other side of. Of this, because I do consider it still part of the holistic medicine that we need to really maximize success for our patients. **Michelle Oravitz:** Awesome. Well,  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** Jane, this is such a pleasure Of talking to you. You've given us some, so much great information and we've definitely dived into a, do a topic that I don't typically, I haven't yet spoken about. But, um, that being said, it's such an important topic to talk about. And thank you so much for coming on today. **Michelle Oravitz:** Oh,  **Dr. Nirali Jain:** course. **Michelle Oravitz:** I get off, how can people find you?  **Dr. Nirali Jain:** That's a great question. So I have, um, a social media page. I, it's called Expert nc. So like EGG,  **Michelle Oravitz:** I  **Dr. Nirali Jain:** um, expert nc. Try, tried to make it a little bit humorous. Um, but I'm all over social [00:32:00] media and would love to hear from anyone that is listening. I, you know, every, every day I get different, um, dms and I'm happy to respond. **Dr. Nirali Jain:** I love hearing about everyone else's. Stories and things like that. Um, so that is kind of my main, main social media platform. Um, and then through like RMA and Reproductive Medical Associates, we also have a YouTube channel. We have an Instagram page, um, of our office available, um, as well that is public. **Dr. Nirali Jain:** So you can find us pretty easily if you just kind of hit Google. But um, yeah, I'm kind of developing my social media platform as the expert and I hope it grows.  **Michelle Oravitz:** Love it. Great.  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** was such a pleasure talking to you. Thank you. so much **Dr. Nirali Jain:** Thank you. **Michelle Oravitz:** today.  **Dr. Nirali Jain:** Of course. Thank you so much for having me.  [00:33:00]   

Ras de tierra: Doctora Ana Laura Magaloni, abogada de Nuestro Futuro AC

What makes a residence hall more than just a place to sleep? In this episode, we explore how residence halls can become powerful hubs for belonging, connection, and student growth. Our guest, Dr. Amy Lorenz, shares insights on designing inclusive residential communities, the vital role of RAs and other student leaders, and the intentional programs that help students feel seen, supported, and engaged from day one. Dr. Lorenz serves as the Director of Residence Life at the University of North Florida. Amy's research focuses on student, faculty, and staff experiences in living-learning communities. Amy's professional interests are in student learning and development, peer mentoring, and co-curricular learning experiences.  Additional Resources CITI Program's Higher Education Solution: https://about.citiprogram.org/solutions/higher-education/  

This week hosts Tiffany Cross, Angela Rye, and Andrew Gillum speak with the Mayor of Newark, Ras Baraka. The Mayor made headlines last Friday after he was arrested by ICE while protesting a new ICE detention facility in his home city. Mayor Baraka’s arrest comes in the context of Trump’s sprawling campaign of retribution against his “political enemies.” From law firms, to judges, to universities and elected officials–Trump is weaponizing the federal government against anyone he perceives to have wronged him. The legal attacks are often effective even if his administration doesn’t win the case… Today our hosts discuss government retaliation. The chilling effect of these attacks could have long term impacts on free speech, the application of justice, and our ability to govern. Mayor of Newark, New Jersey, Ras J. Baraka is a Newark native, poet, and educator. Under his leadership, Newark achieved a 60-year low in crime, replaced 23,000 lead service lines, and reduced homelessness by 57%. A member of Alpha Phi Alpha, Ras is a lifelong advocate for equity and opportunity. He’s now running a campaign for Governor of New Jersey. If you’d like to submit a question, check out our tutorial video: http://www.instagram.com/reel/C5j_oBXLIg0/ and send to @nativelandpod. We are 537 days away from the midterm elections. Welcome home y’all! —--------- We want to hear from you! Send us a video @nativelandpod and we may feature you on the podcast. Instagram X/Twitter Facebook NativeLandPod.com Watch full episodes of Native Land Pod here on YouTube. Native Land Pod is brought to you by Reasoned Choice Media. Thank you to the Native Land Pod team: Angela Rye as host, executive producer and cofounder of Reasoned Choice Media; Tiffany Cross as host and producer, Andrew Gillum as host and producer, and Lauren Hansen as executive producer; Loren Mychael is our research producer, and Nikolas Harter is our editor and producer. Special thanks to Chris Morrow and Lenard McKelvey, co-founders of Reasoned Choice Media. Theme music created by Daniel Laurent.See omnystudio.com/listener for privacy information.

Manifestation requires more than just wishful thinking—it demands a scientific approach that aligns our beliefs, attention, and actions with specific outcomes. We explore the neuroscience behind manifestation and provide a practical five-step protocol to make it work in your life.• Manifestation is the process of aligning beliefs, attention, and actions with specific outcomes• The reticular activating system (RAS) filters information based on what we're focused on• Neuroplasticity allows our thoughts and intentions to physically reshape our brain's structure• Mirror neurons and embodiment help normalize our desired version of ourselves• Energetic congruence ensures our emotions align with our desired outcomes• Clarify your outcome by writing it down specifically as if it's already happening• Spend two minutes daily visualizing your goal and anchoring it with a physical cue• Journal as the version of you who has already achieved your goal• Take daily micro-actions that align with your desired outcome• Regulate your nervous system to feel safe receiving what you want• Manifestation combines intention, aligned action, and nervous system safetyWant more tips and strategies for creating your best life? Visit www.jenncody.com and sign up for the free Weekly Balance newsletter.Thanks for listening! Connect With Me:

Kain Medrano was selected by the #commanders with the 205th pick of the 2025 #NFL draft. Medrano has some very intriguing #RAS scores and his story is that of an easy to root for athlete. Medrano has some interesting player comparsions as well. Tune in to this detailed breakdown of Kain Medrano of your Washington Commanders.

Lexi nám prezradila, na koho strane stojí v konflikte medzi Azrou a Noemi, podrobne nám vysvetlila, ako vznikol konflikt medzi Aničkou a Miškou, a dokonca prezradila aj skutočné úmysly Aničky v šou. S kým už teraz nie je v kontakte? Bol podľa nej Rasťo pripravený sa usadiť? A ako vnímala celú šou – od príchodu až po odchod z vily? Toto všetko a ešte oveľa viac sa dozvieš v tomto rozhovore.

In this RA*Chat episode, join host Anthony to discuss the complexities of move-out season for RAs and student staff members--from juggling school and work, to being prepared and planning ahead. Guest Naomi Semb-Lovejoy shares insights on managing this hectic time while supporting yourself and others.

In this eye-opening episode of Managing Money Made Easy, Karen G. Adams welcomes back small business consultant Caroline Armstrong to unpack why traditional goal setting often fails—and what to do instead. Caroline explains how starting with goals like “double your revenue” can lead to burnout and self-sabotage when they're not aligned with how you truly want to feel. Together, they explore the role of emotional alignment, affirmations, and the brain's filtering system (RAS) in setting meaningful, achievable business goals. If you've ever felt stuck or frustrated by goals that just don't stick, this episode will completely reframe your approach.   Book a FREE 30-Min Discovery Call with Karen: https://link.tekmatix.com/widget/group/4MuwLly6AepUaJTXnmo6   Contact Caroline: Teamworks with Caroline | Empowering Small Business Owners Email: caroline@teamworkswithcaroline.com

You've heard about visualization, but are you actually using them to reprogram your mind for healing? Most people aren't — and it's costing them their health and freedom. In this episode, I'm breaking down a simple 5-minute practice that can literally rewire your brain to work for you instead of against you. In this episode, you'll learn:How your brain's RAS filters what you focus on — healing or fear.A simple 5-minute visualization practice to rewire your mind.Why consistency is the key to making it work.Are you ready to stop letting your mind work against you and start using it to heal? Hit play and learn how this simple 5-minute exercise can change everything.Text us your thoughts on this episode!------------------------------------------------------Ready to ditch the fear and become the healer you've been searching for?

In this bonus episode we run through the latest trending topics in pop culture. Ariel Winter opened up in a People magazine exclusive about her troubling childhood and impacts of online vitriol. The A Million Lives book festival is the latest Fyre Festival. Rihanna makes a baby announcement at the 2025 Met Gala. And the Free Luigi movement is alive and well!Deny, Defend, Depose and most importantly - let me know what you think!Instagram - ⁠@moodforfeud⁠ TikTok - ⁠@moodforfeud ⁠⁠⁠Support the show on Ko-fi all funds go towards upgrading my podcast gear!⁠⁠LinksGuest episode on Best Week Ever podcastMommie Dearest: Ariel WinterTimestamps00:57 Ariel Winter exclusive with People magazine21:53 The Fyre Festival for books17:23 Rihanna baby announcement20:40 Free Healthcare, Free Luigi25:56 Zendaya and Tom reclaiming privacyIntro/Outro MusicYarWritten by Ryan SkeltonProduced by Ras & Sakunera#rihanna #metgala #asaprocky #arielwinter #childstar #luigimangione #amillionlivesbook #zendaya #trendingtopics

In today's episode, supported by Revolution Medicines, we spoke with Kathryn C. Arbour, MD, a thoracic medical oncologist at Memorial Sloan Kettering Cancer Center in New York, New York, about 2 important abstracts presented at the 2024 AACR Annual Meeting that explore novel RAS-targeted approaches in non–small cell lung cancer (NSCLC). Our discussion focused on early clinical findings with zoldonrasib (RMC-9805) and daraxonrasib (RMC-6236), both of which are RAS(ON) inhibitors under investigation for the treatment of patients with RAS-mutant NSCLC. Zoldonrasib, a KRAS G12D-selective tri-complex inhibitor, was evaluated in a phase 1 trial (NCT06040541) in patients with previously treated, advanced KRAS G12D–mutated solid tumors, including NSCLC. Daraxonrasib, a multi-selective RAS(ON) inhibitor, was highlighted in another phase 1 trial (NCT05379985) in patients with advanced RAS-mutant tumors, including previously treated NSCLC; notably, this AACR presentation focused on the association between early on-treatment circulating tumor DNA level reduction and clinical response with the agent. In this episode, Dr Arbour shared insights into the mechanisms of action behind these therapies, their respective clinical trial designs, and the potential implications that early data with the agents may have for the evolving RAS-mutant NSCLC treatment paradigm.

ŚB 5.18.6At the end of the millennium, ignorance personified assumed the form of a demon, stole all the Vedas and took them down to the planet of Rasātala. The Supreme Lord, however, in His form of Hayagrīva retrieved the Vedas and returned them to Lord Brahmā when he begged for them. I offer my respectful obeisances unto the Supreme Lord, whose determination never fails.Please feel free to join our Kṛṣṇa Consciousness Telegram group chat (for both prabhujīs and mātājīs): ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://t.me/iskmnews⁠

11:16 - Guest: Kent Lee Platte, creator of the groundbreaking Relative Athletic Score (RAS) metric for NFL Draft prospects, on the Commanders for each of their two NFL Drafts with Adam Peters as general manager being No. 1 in the NFL in average RAS for players taken in the draft, whether prioritizing players who test very well athletically is a wise NFL Draft strategy, why offensive tackle Josh Conerly Jr. most stands out regarding players selected by the Commanders in the 2025 NFL Draft in terms of RAS, perspective on receiver Jaylin Lane and running back Jacory Croskey-Merritt in terms of RAS, when an NFL player's athletic prime truly is and much more 32:45 - Capitals: preview of the Caps' best-of-seven series against the Carolina Hurricanes in the second round of the Stanley Cup Playoffs 44:40 - Nationals: discussion of the Nats winning two out of three games at the Cincinnati Reds 56:40 - Orioles: breakdown of the O's losing two out of three games against the Kansas City Royals Download the PrizePicks app and use the promo code "Galdi" for $50 instantly after you play your first $5 lineup The Nace Law Group, Accident & Injury Lawyers - 202-902-7611 and make sure that you mention that Al Galdi sent you Call Nova Fireplace And Stove at 571-513-3803, mention that Al Galdi sent you and receive $50 off any fireplace service before Sept. 1, 2025 - this includes cleaning, safety inspection, tune-up and diagnostic work For advertising inquiries, email Sales@BlueWirePods.com Please note that time stamps may be slightly off depending on rotating national ads 

Episode 694 - Are your emotions keeping you stuck in the same patterns? Fear, doubt, and anxiety are not just feelings—they shape your brain, nervous system, and reality. In this podcast, I'll break down how survival emotions hijack your mind, how brain wave states impact manifestation, and how you can regulate your nervous system to rewire your subconscious. Plus, I'll explain how the Reticular Activating System (RAS) controls what you notice in life—and how to use it to attract what you truly want.

Imagine flying across the world to get dumped by your partner! This week we're getting into the nitty gritty of JoJo Siwa and Kath Ebbs messy breakup. We discuss JoJo's time on Big Brother, her 'beautiful bond' with Chris Hughes, the cheating allegations and the brutal breakup with Kath at the Big Brother after party. This episode is part of the Ex-Fluencer series, check out previous eps below!Ask your ex for a business class ticket and most importantly - let me know what you think!Instagram - @moodforfeud TikTok - @moodforfeud ⁠Support the show on Ko-fi all funds go towards upgrading my podcast gear!4:00 JoJo Siwa22:32 Kath Ebbs26:50 Relationship timeline31:33 Mickey Rourke34:27 JoJo and Chris Hughes45:06 The breakup55:15 Final thoughtsPrevious EpisodesEx-fluencers #1: Jake Paul and Alissa VioletEx-fluencers #2: Atis Paul and Mikaela TestaIntro/Outro MusicYarWritten by Ryan SkeltonProduced by Ras & Sakunera#jojosiwa #kathebbs #celebritybigbrother #realitytv #celebritybreakup

En este episodio de Código Tumoral, la Dra. Julieta Gómez, oncóloga médica de México, da la bienvenida a la Dra. Carolina Martínez Ciarpaglini, patóloga del Hospital Clínico Universitario de Valencia, España, con amplia experiencia en patología del tracto gastrointestinal y hematolinfoide. A lo largo de la conversación, ambas especialistas reflexionaron sobre la diversidad de biomarcadores utilizados en el cáncer colorrectal metastásico, la implementación de nuevas tecnologías diagnósticas y el papel de la colaboración interdisciplinaria en la medicina de precisión.Durante la charla, se discutieron las principales estrategias diagnósticas en su centro de trabajo, incluyendo el uso universal de inmunohistoquímica para evaluar inestabilidad microsatelital y pruebas por PCR para detectar mutaciones en RAS y BRAF. La Dra. Martínez también abordó el uso selectivo de paneles NGS y la utilidad de la patología digital, destacando su potencial en la automatización y estandarización del análisis de biomarcadores. Finalmente, se conversó sobre los principales retos que enfrentan los patólogos, como la variabilidad entre laboratorios, la necesidad de optimización de muestras pequeñas, y la importancia crítica de una comunicación fluida entre oncólogos y patólogos para implementar de manera efectiva la medicina personalizada.Dentro de su conversación, se plantearon las siguientes preguntas:¿Cuáles son los biomarcadores que recomienda realizar en un paciente con cáncer colorrectal metastásico?¿Cuáles de estos se realizan actualmente en su centro de trabajo?¿Qué papel juega el marcador HER2 en la práctica clínica y en el contexto de ensayos clínicos?¿Cuál es el beneficio de realizar NGS en pacientes con cáncer colorrectal metastásico?¿Cuál es su opinión sobre la patología digital? ¿Cree que tendrá un rol importante en el descubrimiento y evaluación de biomarcadores?¿Cuáles consideras que han sido los mayores retos a los que te has enfrentado como patóloga?¿Qué obstáculos ves actualmente y a futuro en la implementación de nuevas tecnologías en patología oncológica?Fecha de grabación: 15 de abril de 2025.      Todos los comentarios emitidos por los participantes son a título personal y no reflejan la opinión de ScienceLink u otros. Se deberá revisar las indicaciones aprobadas en el país para cada uno de los tratamientos y medicamentos comentados. Las opiniones vertidas en este programa son responsabilidad de los participantes o entrevistados, ScienceLink las ha incluido con fines educativos. Este material está dirigido a profesionales de la salud exclusivamente.

In this episode of ResEdChat, join Noah and Nick Stanford, Senior Academic Advisor at Miami University's College of Engineering and Computing to talk about RA supervision and the concept of "challenge and support" as it relates to that conversation. They discuss challenging RAs to grow as individuals and people, the intricacies of that work, share impactful stories, and offer practical advice for helping RAs not only be successful at their jobs but to grow as students and people as well.

In our final hour, we analyze the RAS scores of all the players drafted this year and compare them to those from Adam Peters' first year at the helm. Using that data, we predict the Commanders' potential draft strategy moving forward. We also preview the Capitals' big matchup tonight and react to the Nationals' heartbreaking loss.

That's a wrap on the 2025 draft, as Tex and Paul take you through an absolutely brilliant experience, filled with great moments. They recap the Packers' day three picks, including a few steals at edge rusher, before tackling some of the interesting UDFAs, including a 220 pound boundary corner. The Packers attacked their positions of need in their typically high-RAS fashion, and it's hard not to be excited about the future.The draft in tiny Green Bay was a huge success, and really couldn't have gone much better. What an absolute blast.

That's a wrap on the 2025 draft, as Tex and Paul take you through an absolutely brilliant experience, filled with great moments. They recap the Packers' day three picks, including a few steals at edge rusher, before tackling some of the interesting UDFAs, including a 220 pound boundary corner. The Packers attacked their positions of need in their typically high-RAS fashion, and it's hard not to be excited about the future.The draft in tiny Green Bay was a huge success, and really couldn't have gone much better. What an absolute blast. Hosted on Acast. See acast.com/privacy for more information.

 Check out the Pine Island Redfish WebsiteCheck out our website!: https://www.globalseafood.org/podcastFollow us on social media!Twitter | Facebook | LinkedIn | InstagramShare your sustainability tips with us podcast@globalseafood.org!If you want to be more involved in the work that we do, become a member of the Global Seafood Alliance: https://www.globalseafood.org/membership/ The views expressed by external guests on Aquademia are their own and do not reflect the opinions of Aquademia or the Global Seafood Alliance. Listeners are advised to independently verify information and consult experts for any specific advice or decisions.

With the NFL Draft just around the corner, Ryan Schlipp dives deep into Brian Gutekunst's recent press conference and the chaos of fan speculation. Ryan breaks down the ongoing debate over traits vs. production, the misconceptions around the Packers' use of RAS, and the wild draft rumors swirling around Will Johnson and Jaire Alexander. From projecting college talent to handling trade-up scenarios, this episode is a full pre-draft masterclass on how the Packers build their board. Plus, thoughts on Quay Walker, Devonte Wyatt, and the mystery of Tetero McMillan. To advertise on this podcast please email: ad-sales@libsyn.com Or go to: https://advertising.libsyn.com/packernetpodcast

On today's show, Ross Uglem is joined by RAS creator Kent Lee Platte to explain the RAS tool and how it's best utilized. Don't miss it!Packers Draft Guide: https://draftguide.gumroad.com/l/greenbay25/dailyHomage: http://homage.sjv.io/Packers

With the NFL Draft just around the corner, Ryan Schlipp dives deep into Brian Gutekunst's recent press conference and the chaos of fan speculation. Ryan breaks down the ongoing debate over traits vs. production, the misconceptions around the Packers' use of RAS, and the wild draft rumors swirling around Will Johnson and Jaire Alexander. From projecting college talent to handling trade-up scenarios, this episode is a full pre-draft masterclass on how the Packers build their board. Plus, thoughts on Quay Walker, Devonte Wyatt, and the mystery of Tetero McMillan. To advertise on this podcast please email: ad-sales@libsyn.com Or go to: https://advertising.libsyn.com/packernetpodcast

Send us a textIn this episode, I explore the journey of Robin, a 45-year-old art teacher navigating a high cholesterol diagnosis and the frustrating world of weight-centric healthcare. Through their story, I break down the actual science of heart disease risk factors (spoiler: weight is the least of your concerns), explain the difference between primary and secondary prevention, and reveal how the medical establishment's obsession with numbers obscures more important social determinants of health. I also dissect the evidence (or lack thereof) for dietary and lifestyle interventions, highlighting how medication decisions should be based on informed consent, not fear.This episode asks: What if doctors treated us as whole people instead of just collections of numbers?This week's journal article is:  Ras, Rouyanne T et al. “LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies.” The British journal of nutrition vol. 112,2 (2014): 214-9. doi:10.1017/S0007114514000750 Got a question for the next podcast? Let me know! Connect With Me FREE GUIDES: evidence-based, not diet nonsense NEWSLETTER: Life-changing insights straight to your inbox UNSHRINKABLE: Find out why your body is not designed to shrink MASTERCLASSES: All the evidence doctors should give you NO WEIGH PROGRAM: Join the revolution against weight-loss lies THE WEIGHTING ROOM: A community where authenticity thrives and every voice matters CONSULTATION: For the ultimate transformation in your healthcare journe Find me on Instagram, YouTube, and LinkedIn.

Michal Červený a Rasťo Kačmár sú dvaja novinári Denníka N. Ich podcast Otcovia v plienkach vznikol v kuchynke, kde spolu preberali slasti aj strasti okolo ich novej otcovskej roly.Chalani sú skvelí hostia do podcastu, sú zvedaví, komunikatívni, láskaví a zároveň otvorení. Neboja sa hovoriť aj o emóciách, ktoré sú v mužskom svete tabu. Rozprávali sme sa ako sa s príchodom novej roly menili ich postoje, o tom ako si budujú vzťah s deťmi, ako hľadajú balans medzi rodinou a kariérou aj o tlaku spoločnosti na moderných otcov.V úvode podcastu si vypočujete náš neriadený rozhovor o čerstvých zážitkoch z veľkej noci.A pripomíname tiež kód mamagang_stojancek na www.bikeup.rent. Do konca apríla môžete získať k predplatnému superľahkého detského bajku stojanček zdarma.

No s'ho esperava. Ras i curt. D'aquí la sorpresa de Jordi Milán al rebre la trucada de la Generalitat comunicant-li que a La Cubana li ha estat atorgada una de les creus de Sant Jordi del 2025. Més enllà de la satisfacció, en l'any del 45è aniversari de la companyia, Milán es referma, però, en el valor de l'apreci del públic i d'haver pogut arribar fins aquí vivint del teatre. Al palau Robert continua oberta l'exposició '45 anys jugant a fer teatre' i el setembre s'estrenarà el musical basat en la comèdia de Rafael Anglada 'L'amor venia en taxi'. L'entrada La Cubana rep la creu de Sant Jordi, i Jordi Milán ho viu entre la satisfacció i la sorpresa ha aparegut primer a Radio Maricel.

If you've tried everything to get healthy with type 2 diabetes and nothing sticks. What if you are not focusing on the right “right” problem? Maybe it's time to look at your beliefs (not your food). This episode reveals how your brain's Reticular Activating System (RAS) creates your experience by filtering in what you already believe. Whether it's “this is too hard” or “I always fail,” your RAS is finding evidence to prove it true. But here's the good news—you can shift your focus, change your beliefs, and get very different results. Learn how to direct your RAS so your brain starts working for your health, not against it.

Spojené státy nejsou aktivní jenom směrem k Ukrajině, ale i v oblasti Rudého moře. Americká armáda v rámci své kampaně proti jemenským povstalcům Húsíům zničila ropný přístav Ras Ísá. „Cílem této operace je oslabit vliv Íránu v oblasti, useknout chapadla íránským proxy spojencům,“ vysvětluje odborník na mezinárodní vztahy Vlastislav Bříza. Co bylo cílem návštěvy saúdskoarabského ministra obrany v Teheránu? A které evropské země by měly zdvojnásobit svou pomoc Ukrajině?

HELLO we're back for part TWO of the "you've been brainwashed to think you need to work" series, where we talk alllll about the energetics and TRUTH about money. We cover how your money beliefs are formed, how your brain uses these beliefs as a way of constructing your money experience, how your RAS blocks out money opportunities that don't align with your belief system, what energy really is and how your energy creates your money results.Save money and sign up for the "Your Brain is the Universe: Unlocking Infinite Potential" LIVE workshop on May 5th here.Join the UNDO membership here to undo the patterns keeping you stuck.Watch the podcast on YouTube here.Join my newsletter here.Links to my app, meditations, discounts, workshops here.Send in your "DO or UNDO's" here.Don't forget to subscribe so you never miss an episode!

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Send us a textDo you have brain bouncers blocking your goals?No, really—we're not talking about the velvet-rope kind of bouncers (though wouldn't that be fun?). We're talking about the ones in your mind that determine what gets through… and what doesn't.In this episode, we're pulling back the curtain on one of the most powerful and overlooked features of your brain: the Reticular Activating System—a.k.a. the RAS.This episode is especially for you if: ✨ You've ever felt like you're working hard but not gaining traction ✨ You're ready to stop reacting and start designing your days ✨ You're craving more intention, abundance, and clarity in your life and leadershipWe've all heard the phrase, “What you focus on grows.” But what if that's not just cute advice—it's actual neuroscience?Your RAS is the gatekeeper between your conscious and subconscious mind. It's the internal filter scanning your world 24/7 for what matters to you. That red car you suddenly see everywhere? That's your RAS in action. The neighborhood you never noticed—until you started house hunting? Yep, RAS again.So how do we use this system to our advantage?In this episode, Alex and Carol get personal, playful, and practical as they walk you through:

87% of successful people attribute their achievements to mindset—but what if your mindset isn't just what you believe… it's what you say?In this solo episode, I break down the one thing I've seen make or break success for myself, my clients, and some of the most influential leaders I know: language. The words you speak—internally and externally—are either building your future or reinforcing your limitations.Whether you're a founder, a parent, or a high performer, this episode will give you a powerful reframe for how to speak life into your goals instead of draining their energy before they even start.What You'll Learn in This EpisodeThe science behind how words rewire your brain (RAS + neuroscience meets faith)How giving pain a voice gives it power—and how to reclaim your voiceWhy mindset shifts are rooted in language patterns, not just positive thinkingA 3-part framework to transform your inner dialogue and external communicationHow to reframe limiting beliefs in real timeWhy your words are the seeds for tomorrow's results—and how to plant wiselyKey Takeaways✔️Your words shape your focus, which shapes your actions.✔️Negative self-talk decreases problem-solving ability by 31%.✔️Saying “I'm overwhelmed” reinforces powerlessness—reframe it to “I'm prioritizing what matters.”✔️Giving pain a voice gives it more power—acknowledge it, but don't amplify it.✔️The 3-part framework:Catch and correct negative language.Speak what you want to see, not what you want to avoid.Surround yourself with life-giving words and voices.✔️Your inner dialogue becomes your outer reality—speak accordingly.✔️You wouldn't speak to a child the way you speak to yourself—why is that okay?Timestamps[00:00] – How mindset + neuroscience prove the power of language[02:00] – Words either create your dream or drain its power[04:00] – The quote that shifted my entire perspective[06:00] – Why giving pain a voice gives it energy[08:00] – Shifting from describing your reality to creating it[10:00] – Framework Part 1: Catch and correct your language[12:00] – Framework Part 2: Speak what you want to see[14:00] – Framework Part 3: Surround yourself with life-giving words[16:00] – Why your environment is programming your reality[18:00] – The 30-second venting rule (and why it works)[20:00] – Challenge: Monitor your language for 24 hours[21:00] – A hack that changed my self-talk forever[22:00] – Final thoughts and an invitation to speak life into othersChoose Your Next Steps:Monitor your words for 24 hours.Notice how you speak in moments of frustration or doubt.Flip every negative statement into a possibility-driven reframe.DM me your favorite reframe or post it and tag me @itsgeorgebryant. I want to hear your breakthroughs.Special Invitation: Work With MeReady to build a business rooted in trust, alignment, and real results?Apply for 1:1 coaching or join the Relationship Beats Algorithms Alliance.Get on the list for the next live event at mindofgeorge.com/event

Nyheter och fördjupning från Sverige och världen. Lyssna på alla avsnitt i Sveriges Radio Play.

Lisamarie Tomassetti, Program Coordinator for Residential Education at UNLV, discussed the benefits of on-campus living, including convenience, access to resources, and community engagement. She highlighted the "Rebel Ready Week" for new students, free programming funded by housing fees, and the role of RAs in fostering student success. Theme floors, such as engineering and fine arts, enhance academic engagement. Dining options include mandatory meal plans with various options, and security measures ensure student safety. Lisa also mentioned upcoming events like a scooter raffle and a banquet for housing staff. She emphasized the importance of early student involvement and the modernization of housing facilities.

Send Dr. Li a text here. Please leave your email address if you would like a reply, thanks.Get ready to boost your self-confidence and banish negativity with the latest episode of the Make Time for Success podcast! In Episode 225, Dr. Christine Li introduces a powerful exercise called the "affirmations waterfall." This technique is designed to fill your mind with positive thoughts, helping you to overcome self-limiting beliefs and head straight for your goals. Discover how to craft your own cascade of affirmations and learn why this practice is so effective in rewiring your brain for success. Tune in to embrace positivity and create a more confident you!Timestamps:[00:03:17] Description of the affirmations waterfall exercise.[00:05:12] Discussion on the effectiveness of affirmations.[00:07:19] Why do affirmations work?[00:08:24] Explanation of neuroplasticity.[00:09:39] Interrupting the negativity bias.[00:11:08] Role of the reticular activating system (RAS).[00:13:40] Influence on behavior change by affirmations.[00:15:08] Introduction to Dr. Li's personal affirmations.[00:17:33] Tips on creating your own affirmations waterfall.[00:19:44] Suggestions for dealing with difficult material that may arise.To receive the free Affirmations Waterfall download, go to https://maketimeforsuccesspodcast.com/waterfallTo sign up for the Waitlist for Dr. Li's signature program Simply Productive, go to https://maketimeforsuccesspodcast.com/SPFor more information on the Make Time for Success podcast, visit: https://www.maketimeforsuccesspodcast.comGain Access to Dr. Christine Li's Free Resource Library -- 12 downloadable tools and templates to help you bypass the impulse to procrastinate: https://procrastinationcoach.mykajabi.com/freelibraryTo work with Dr. Li on a weekly basis in her coaching and accountability program, register for The Success Lab here: https://www.procrastinationcoach.com/labConnect with Us!Dr. Christine LiWebsite: https://www.procrastinationcoach.comFacebook Group: https://www.facebook.com/groups/procrastinationcoachInstagram: https://www.instagram.com/procrastinationcoach/TikTok: https://www.tiktok.com/@procrastinationcoachThe Success Lab: https://maketimeforsuccesspodcast.com/lab                        Simply Productive: https://maketimeforsuccesspodcast.com/SP

Did you know your brain has a secret weapon for healing Hashimoto's? If fatigue or flare-ups have you feeling stuck, this episode is your game-changer. I'm Esther, and I'm sharing how a tiny part of your brain—the reticular activating system, or RAS—can help you take charge of your health. Living with Hashimoto's can be a lot, but your brain is built to sift through the chaos and focus on what matters. You'll learn how your RAS filters distractions, simple tricks to point it toward goals like going gluten-free or boosting energy, and why knowing your root causes makes it work even better. Hit play and let's focus on healing together!   JOIN THE COMMUNITY Unlock your wellness journey with the free Health with Hashimoto's community! Join a supportive community that's here for you every step of the way. https://www.skool.com/health-with-hashimotos/about   YOUR PATH TO HEALTH WITH HASHIMOTO'S   STEP 1 - Hashimoto's Decoded: 10 Thyroid Questions to Ask Your Doctor. https://healthwithhashimotos.com/questions-for-your-doctor/   STEP 2 - Hashimoto's Decoded: Root Causes Revealed. https://healthwithhashimotos.com/hashimotos-decoded/   STEP 3: The Holistic Hashimoto's Course https://healthwithhashimotos.com/holistic-hashimotos-course/      ABOUT THE PODCAST & ESTHER: The Health with Hashimoto's podcast will help you explore the root causes of your autoimmune condition and discover holistic solutions to address your Hashimoto's thyroiditis. It is hosted by Esther Yunkin, a registered nurse, holistic health educator, and Hashimoto's warrior.   This podcast is for informational and educational purposes. Please discuss any questions or concerns with your healthcare professional.

In Episode 225 of the Footballguys Fantasy Football Show, Dave Kluge and Alfredo Brown are joined by Kent Lee Platte, the creator of Relative Athletic Score. They'll discuss the history and methodology behind RAS before talking about some of their favorite athletic standouts from this year's rookie class. Send your questions to fantasyshow@footballguys.com  

Can embracing gratitude truly reshape your perspective on life and open doors to unexpected opportunities? In this solo episode of the Secrets to Abundant Living Podcast, host Amy Sylvis explores the profound impact of focusing on the good amidst uncertainty. Amy reveals how you can train your brain using the reticular activating system (RAS) to filter in positivity and seize opportunities. With actionable steps and personal stories, she empowers you to regain control over your personal circumstances. Expect to learn about the transformative power of gratitude, effective goal setting, and the importance of community support. Tune in to discover how these insights can help you navigate an uncertain world and make 2025 your best year yet. Get ready for an inspiring pep talk and practical advice that can change your life.Connect with Amy Sylvis:https://www.linkedin.com/in/amysylvis/Contact Us:https://www.sylviscapital.comhttps://www.sylviscapital.com/webinar00:00 Introduction to Gratitude and Brain Training00:36 Welcome to the Secrets to Abundant Living Podcast01:25 Springtime Energy and Real Estate Investment02:52 Facing Uncertainty with Grit and Resilience05:34 Understanding and Programming Your Reticular Activating System11:32 The Power of Gratitude and Goal Setting13:39 Opportunities in Times of Uncertainty17:15 Invitation to Free Real Estate Training18:13 Closing Remarks and Encouragement

If you're in SF: Join us for the Claude Plays Pokemon hackathon this Sunday!If you're not: Fill out the 2025 State of AI Eng survey for $250 in Amazon cards!We are SO excited to share our conversation with Dharmesh Shah, co-founder of HubSpot and creator of Agent.ai.A particularly compelling concept we discussed is the idea of "hybrid teams" - the next evolution in workplace organization where human workers collaborate with AI agents as team members. Just as we previously saw hybrid teams emerge in terms of full-time vs. contract workers, or in-office vs. remote workers, Dharmesh predicts that the next frontier will be teams composed of both human and AI members. This raises interesting questions about team dynamics, trust, and how to effectively delegate tasks between human and AI team members.The discussion of business models in AI reveals an important distinction between Work as a Service (WaaS) and Results as a Service (RaaS), something Dharmesh has written extensively about. While RaaS has gained popularity, particularly in customer support applications where outcomes are easily measurable, Dharmesh argues that this model may be over-indexed. Not all AI applications have clearly definable outcomes or consistent economic value per transaction, making WaaS more appropriate in many cases. This insight is particularly relevant for businesses considering how to monetize AI capabilities.The technical challenges of implementing effective agent systems are also explored, particularly around memory and authentication. Shah emphasizes the importance of cross-agent memory sharing and the need for more granular control over data access. He envisions a future where users can selectively share parts of their data with different agents, similar to how OAuth works but with much finer control. This points to significant opportunities in developing infrastructure for secure and efficient agent-to-agent communication and data sharing.Other highlights from our conversation* The Evolution of AI-Powered Agents – Exploring how AI agents have evolved from simple chatbots to sophisticated multi-agent systems, and the role of MCPs in enabling that.* Hybrid Digital Teams and the Future of Work – How AI agents are becoming teammates rather than just tools, and what this means for business operations and knowledge work.* Memory in AI Agents – The importance of persistent memory in AI systems and how shared memory across agents could enhance collaboration and efficiency.* Business Models for AI Agents – Exploring the shift from software as a service (SaaS) to work as a service (WaaS) and results as a service (RaaS), and what this means for monetization.* The Role of Standards Like MCP – Why MCP has been widely adopted and how it enables agent collaboration, tool use, and discovery.* The Future of AI Code Generation and Software Engineering – How AI-assisted coding is changing the role of software engineers and what skills will matter most in the future.* Domain Investing and Efficient Markets – Dharmesh's approach to domain investing and how inefficiencies in digital asset markets create business opportunities.* The Philosophy of Saying No – Lessons from "Sorry, You Must Pass" and how prioritization leads to greater productivity and focus.Timestamps* 00:00 Introduction and Guest Welcome* 02:29 Dharmesh Shah's Journey into AI* 05:22 Defining AI Agents* 06:45 The Evolution and Future of AI Agents* 13:53 Graph Theory and Knowledge Representation* 20:02 Engineering Practices and Overengineering* 25:57 The Role of Junior Engineers in the AI Era* 28:20 Multi-Agent Systems and MCP Standards* 35:55 LinkedIn's Legal Battles and Data Scraping* 37:32 The Future of AI and Hybrid Teams* 39:19 Building Agent AI: A Professional Network for Agents* 40:43 Challenges and Innovations in Agent AI* 45:02 The Evolution of UI in AI Systems* 01:00:25 Business Models: Work as a Service vs. Results as a Service* 01:09:17 The Future Value of Engineers* 01:09:51 Exploring the Role of Agents* 01:10:28 The Importance of Memory in AI* 01:11:02 Challenges and Opportunities in AI Memory* 01:12:41 Selective Memory and Privacy Concerns* 01:13:27 The Evolution of AI Tools and Platforms* 01:18:23 Domain Names and AI Projects* 01:32:08 Balancing Work and Personal Life* 01:35:52 Final Thoughts and ReflectionsTranscriptAlessio [00:00:04]: Hey everyone, welcome back to the Latent Space podcast. This is Alessio, partner and CTO at Decibel Partners, and I'm joined by my co-host Swyx, founder of Small AI.swyx [00:00:12]: Hello, and today we're super excited to have Dharmesh Shah to join us. I guess your relevant title here is founder of Agent AI.Dharmesh [00:00:20]: Yeah, that's true for this. Yeah, creator of Agent.ai and co-founder of HubSpot.swyx [00:00:25]: Co-founder of HubSpot, which I followed for many years, I think 18 years now, gonna be 19 soon. And you caught, you know, people can catch up on your HubSpot story elsewhere. I should also thank Sean Puri, who I've chatted with back and forth, who's been, I guess, getting me in touch with your people. But also, I think like, just giving us a lot of context, because obviously, My First Million joined you guys, and they've been chatting with you guys a lot. So for the business side, we can talk about that, but I kind of wanted to engage your CTO, agent, engineer side of things. So how did you get agent religion?Dharmesh [00:01:00]: Let's see. So I've been working, I'll take like a half step back, a decade or so ago, even though actually more than that. So even before HubSpot, the company I was contemplating that I had named for was called Ingenisoft. And the idea behind Ingenisoft was a natural language interface to business software. Now realize this is 20 years ago, so that was a hard thing to do. But the actual use case that I had in mind was, you know, we had data sitting in business systems like a CRM or something like that. And my kind of what I thought clever at the time. Oh, what if we used email as the kind of interface to get to business software? And the motivation for using email is that it automatically works when you're offline. So imagine I'm getting on a plane or I'm on a plane. There was no internet on planes back then. It's like, oh, I'm going through business cards from an event I went to. I can just type things into an email just to have them all in the backlog. When it reconnects, it sends those emails to a processor that basically kind of parses effectively the commands and updates the software, sends you the file, whatever it is. And there was a handful of commands. I was a little bit ahead of the times in terms of what was actually possible. And I reattempted this natural language thing with a product called ChatSpot that I did back 20...swyx [00:02:12]: Yeah, this is your first post-ChatGPT project.Dharmesh [00:02:14]: I saw it come out. Yeah. And so I've always been kind of fascinated by this natural language interface to software. Because, you know, as software developers, myself included, we've always said, oh, we build intuitive, easy-to-use applications. And it's not intuitive at all, right? Because what we're doing is... We're taking the mental model that's in our head of what we're trying to accomplish with said piece of software and translating that into a series of touches and swipes and clicks and things like that. And there's nothing natural or intuitive about it. And so natural language interfaces, for the first time, you know, whatever the thought is you have in your head and expressed in whatever language that you normally use to talk to yourself in your head, you can just sort of emit that and have software do something. And I thought that was kind of a breakthrough, which it has been. And it's gone. So that's where I first started getting into the journey. I started because now it actually works, right? So once we got ChatGPT and you can take, even with a few-shot example, convert something into structured, even back in the ChatGP 3.5 days, it did a decent job in a few-shot example, convert something to structured text if you knew what kinds of intents you were going to have. And so that happened. And that ultimately became a HubSpot project. But then agents intrigued me because I'm like, okay, well, that's the next step here. So chat's great. Love Chat UX. But if we want to do something even more meaningful, it felt like the next kind of advancement is not this kind of, I'm chatting with some software in a kind of a synchronous back and forth model, is that software is going to do things for me in kind of a multi-step way to try and accomplish some goals. So, yeah, that's when I first got started. It's like, okay, what would that look like? Yeah. And I've been obsessed ever since, by the way.Alessio [00:03:55]: Which goes back to your first experience with it, which is like you're offline. Yeah. And you want to do a task. You don't need to do it right now. You just want to queue it up for somebody to do it for you. Yes. As you think about agents, like, let's start at the easy question, which is like, how do you define an agent? Maybe. You mean the hardest question in the universe? Is that what you mean?Dharmesh [00:04:12]: You said you have an irritating take. I do have an irritating take. I think, well, some number of people have been irritated, including within my own team. So I have a very broad definition for agents, which is it's AI-powered software that accomplishes a goal. Period. That's it. And what irritates people about it is like, well, that's so broad as to be completely non-useful. And I understand that. I understand the criticism. But in my mind, if you kind of fast forward months, I guess, in AI years, the implementation of it, and we're already starting to see this, and we'll talk about this, different kinds of agents, right? So I think in addition to having a usable definition, and I like yours, by the way, and we should talk more about that, that you just came out with, the classification of agents actually is also useful, which is, is it autonomous or non-autonomous? Does it have a deterministic workflow? Does it have a non-deterministic workflow? Is it working synchronously? Is it working asynchronously? Then you have the different kind of interaction modes. Is it a chat agent, kind of like a customer support agent would be? You're having this kind of back and forth. Is it a workflow agent that just does a discrete number of steps? So there's all these different flavors of agents. So if I were to draw it in a Venn diagram, I would draw a big circle that says, this is agents, and then I have a bunch of circles, some overlapping, because they're not mutually exclusive. And so I think that's what's interesting, and we're seeing development along a bunch of different paths, right? So if you look at the first implementation of agent frameworks, you look at Baby AGI and AutoGBT, I think it was, not Autogen, that's the Microsoft one. They were way ahead of their time because they assumed this level of reasoning and execution and planning capability that just did not exist, right? So it was an interesting thought experiment, which is what it was. Even the guy that, I'm an investor in Yohei's fund that did Baby AGI. It wasn't ready, but it was a sign of what was to come. And so the question then is, when is it ready? And so lots of people talk about the state of the art when it comes to agents. I'm a pragmatist, so I think of the state of the practical. It's like, okay, well, what can I actually build that has commercial value or solves actually some discrete problem with some baseline of repeatability or verifiability?swyx [00:06:22]: There was a lot, and very, very interesting. I'm not irritated by it at all. Okay. As you know, I take a... There's a lot of anthropological view or linguistics view. And in linguistics, you don't want to be prescriptive. You want to be descriptive. Yeah. So you're a goals guy. That's the key word in your thing. And other people have other definitions that might involve like delegated trust or non-deterministic work, LLM in the loop, all that stuff. The other thing I was thinking about, just the comment on Baby AGI, LGBT. Yeah. In that piece that you just read, I was able to go through our backlog and just kind of track the winter of agents and then the summer now. Yeah. And it's... We can tell the whole story as an oral history, just following that thread. And it's really just like, I think, I tried to explain the why now, right? Like I had, there's better models, of course. There's better tool use with like, they're just more reliable. Yep. Better tools with MCP and all that stuff. And I'm sure you have opinions on that too. Business model shift, which you like a lot. I just heard you talk about RAS with MFM guys. Yep. Cost is dropping a lot. Yep. Inference is getting faster. There's more model diversity. Yep. Yep. I think it's a subtle point. It means that like, you have different models with different perspectives. You don't get stuck in the basin of performance of a single model. Sure. You can just get out of it by just switching models. Yep. Multi-agent research and RL fine tuning. So I just wanted to let you respond to like any of that.Dharmesh [00:07:44]: Yeah. A couple of things. Connecting the dots on the kind of the definition side of it. So we'll get the irritation out of the way completely. I have one more, even more irritating leap on the agent definition thing. So here's the way I think about it. By the way, the kind of word agent, I looked it up, like the English dictionary definition. The old school agent, yeah. Is when you have someone or something that does something on your behalf, like a travel agent or a real estate agent acts on your behalf. It's like proxy, which is a nice kind of general definition. So the other direction I'm sort of headed, and it's going to tie back to tool calling and MCP and things like that, is if you, and I'm not a biologist by any stretch of the imagination, but we have these single-celled organisms, right? Like the simplest possible form of what one would call life. But it's still life. It just happens to be single-celled. And then you can combine cells and then cells become specialized over time. And you have much more sophisticated organisms, you know, kind of further down the spectrum. In my mind, at the most fundamental level, you can almost think of having atomic agents. What is the simplest possible thing that's an agent that can still be called an agent? What is the equivalent of a kind of single-celled organism? And the reason I think that's useful is right now we're headed down the road, which I think is very exciting around tool use, right? That says, okay, the LLMs now can be provided a set of tools that it calls to accomplish whatever it needs to accomplish in the kind of furtherance of whatever goal it's trying to get done. And I'm not overly bothered by it, but if you think about it, if you just squint a little bit and say, well, what if everything was an agent? And what if tools were actually just atomic agents? Because then it's turtles all the way down, right? Then it's like, oh, well, all that's really happening with tool use is that we have a network of agents that know about each other through something like an MMCP and can kind of decompose a particular problem and say, oh, I'm going to delegate this to this set of agents. And why do we need to draw this distinction between tools, which are functions most of the time? And an actual agent. And so I'm going to write this irritating LinkedIn post, you know, proposing this. It's like, okay. And I'm not suggesting we should call even functions, you know, call them agents. But there is a certain amount of elegance that happens when you say, oh, we can just reduce it down to one primitive, which is an agent that you can combine in complicated ways to kind of raise the level of abstraction and accomplish higher order goals. Anyway, that's my answer. I'd say that's a success. Thank you for coming to my TED Talk on agent definitions.Alessio [00:09:54]: How do you define the minimum viable agent? Do you already have a definition for, like, where you draw the line between a cell and an atom? Yeah.Dharmesh [00:10:02]: So in my mind, it has to, at some level, use AI in order for it to—otherwise, it's just software. It's like, you know, we don't need another word for that. And so that's probably where I draw the line. So then the question, you know, the counterargument would be, well, if that's true, then lots of tools themselves are actually not agents because they're just doing a database call or a REST API call or whatever it is they're doing. And that does not necessarily qualify them, which is a fair counterargument. And I accept that. It's like a good argument. I still like to think about—because we'll talk about multi-agent systems, because I think—so we've accepted, which I think is true, lots of people have said it, and you've hopefully combined some of those clips of really smart people saying this is the year of agents, and I completely agree, it is the year of agents. But then shortly after that, it's going to be the year of multi-agent systems or multi-agent networks. I think that's where it's going to be headed next year. Yeah.swyx [00:10:54]: Opening eyes already on that. Yeah. My quick philosophical engagement with you on this. I often think about kind of the other spectrum, the other end of the cell spectrum. So single cell is life, multi-cell is life, and you clump a bunch of cells together in a more complex organism, they become organs, like an eye and a liver or whatever. And then obviously we consider ourselves one life form. There's not like a lot of lives within me. I'm just one life. And now, obviously, I don't think people don't really like to anthropomorphize agents and AI. Yeah. But we are extending our consciousness and our brain and our functionality out into machines. I just saw you were a Bee. Yeah. Which is, you know, it's nice. I have a limitless pendant in my pocket.Dharmesh [00:11:37]: I got one of these boys. Yeah.swyx [00:11:39]: I'm testing it all out. You know, got to be early adopters. But like, we want to extend our personal memory into these things so that we can be good at the things that we're good at. And, you know, machines are good at it. Machines are there. So like, my definition of life is kind of like going outside of my own body now. I don't know if you've ever had like reflections on that. Like how yours. How our self is like actually being distributed outside of you. Yeah.Dharmesh [00:12:01]: I don't fancy myself a philosopher. But you went there. So yeah, I did go there. I'm fascinated by kind of graphs and graph theory and networks and have been for a long, long time. And to me, we're sort of all nodes in this kind of larger thing. It just so happens that we're looking at individual kind of life forms as they exist right now. But so the idea is when you put a podcast out there, there's these little kind of nodes you're putting out there of like, you know, conceptual ideas. Once again, you have varying kind of forms of those little nodes that are up there and are connected in varying and sundry ways. And so I just think of myself as being a node in a massive, massive network. And I'm producing more nodes as I put content or ideas. And, you know, you spend some portion of your life collecting dots, experiences, people, and some portion of your life then connecting dots from the ones that you've collected over time. And I found that really interesting things happen and you really can't know in advance how those dots are necessarily going to connect in the future. And that's, yeah. So that's my philosophical take. That's the, yes, exactly. Coming back.Alessio [00:13:04]: Yep. Do you like graph as an agent? Abstraction? That's been one of the hot topics with LandGraph and Pydantic and all that.Dharmesh [00:13:11]: I do. The thing I'm more interested in terms of use of graphs, and there's lots of work happening on that now, is graph data stores as an alternative in terms of knowledge stores and knowledge graphs. Yeah. Because, you know, so I've been in software now 30 plus years, right? So it's not 10,000 hours. It's like 100,000 hours that I've spent doing this stuff. And so I've grew up with, so back in the day, you know, I started on mainframes. There was a product called IMS from IBM, which is basically an index database, what we'd call like a key value store today. Then we've had relational databases, right? We have tables and columns and foreign key relationships. We all know that. We have document databases like MongoDB, which is sort of a nested structure keyed by a specific index. We have vector stores, vector embedding database. And graphs are interesting for a couple of reasons. One is, so it's not classically structured in a relational way. When you say structured database, to most people, they're thinking tables and columns and in relational database and set theory and all that. Graphs still have structure, but it's not the tables and columns structure. And you could wonder, and people have made this case, that they are a better representation of knowledge for LLMs and for AI generally than other things. So that's kind of thing number one conceptually, and that might be true, I think is possibly true. And the other thing that I really like about that in the context of, you know, I've been in the context of data stores for RAG is, you know, RAG, you say, oh, I have a million documents, I'm going to build the vector embeddings, I'm going to come back with the top X based on the semantic match, and that's fine. All that's very, very useful. But the reality is something gets lost in the chunking process and the, okay, well, those tend, you know, like, you don't really get the whole picture, so to speak, and maybe not even the right set of dimensions on the kind of broader picture. And it makes intuitive sense to me that if we did capture it properly in a graph form, that maybe that feeding into a RAG pipeline will actually yield better results for some use cases, I don't know, but yeah.Alessio [00:15:03]: And do you feel like at the core of it, there's this difference between imperative and declarative programs? Because if you think about HubSpot, it's like, you know, people and graph kind of goes hand in hand, you know, but I think maybe the software before was more like primary foreign key based relationship, versus now the models can traverse through the graph more easily.Dharmesh [00:15:22]: Yes. So I like that representation. There's something. It's just conceptually elegant about graphs and just from the representation of it, they're much more discoverable, you can kind of see it, there's observability to it, versus kind of embeddings, which you can't really do much with as a human. You know, once they're in there, you can't pull stuff back out. But yeah, I like that kind of idea of it. And the other thing that's kind of, because I love graphs, I've been long obsessed with PageRank from back in the early days. And, you know, one of the kind of simplest algorithms in terms of coming up, you know, with a phone, everyone's been exposed to PageRank. And the idea is that, and so I had this other idea for a project, not a company, and I have hundreds of these, called NodeRank, is to be able to take the idea of PageRank and apply it to an arbitrary graph that says, okay, I'm going to define what authority looks like and say, okay, well, that's interesting to me, because then if you say, I'm going to take my knowledge store, and maybe this person that contributed some number of chunks to the graph data store has more authority on this particular use case or prompt that's being submitted than this other one that may, or maybe this one was more. popular, or maybe this one has, whatever it is, there should be a way for us to kind of rank nodes in a graph and sort them in some, some useful way. Yeah.swyx [00:16:34]: So I think that's generally useful for, for anything. I think the, the problem, like, so even though at my conferences, GraphRag is super popular and people are getting knowledge, graph religion, and I will say like, it's getting space, getting traction in two areas, conversation memory, and then also just rag in general, like the, the, the document data. Yeah. It's like a source. Most ML practitioners would say that knowledge graph is kind of like a dirty word. The graph database, people get graph religion, everything's a graph, and then they, they go really hard into it and then they get a, they get a graph that is too complex to navigate. Yes. And so like the, the, the simple way to put it is like you at running HubSpot, you know, the power of graphs, the way that Google has pitched them for many years, but I don't suspect that HubSpot itself uses a knowledge graph. No. Yeah.Dharmesh [00:17:26]: So when is it over engineering? Basically? It's a great question. I don't know. So the question now, like in AI land, right, is the, do we necessarily need to understand? So right now, LLMs for, for the most part are somewhat black boxes, right? We sort of understand how the, you know, the algorithm itself works, but we really don't know what's going on in there and, and how things come out. So if a graph data store is able to produce the outcomes we want, it's like, here's a set of queries I want to be able to submit and then it comes out with useful content. Maybe the underlying data store is as opaque as a vector embeddings or something like that, but maybe it's fine. Maybe we don't necessarily need to understand it to get utility out of it. And so maybe if it's messy, that's okay. Um, that's, it's just another form of lossy compression. Uh, it's just lossy in a way that we just don't completely understand in terms of, because it's going to grow organically. Uh, and it's not structured. It's like, ah, we're just gonna throw a bunch of stuff in there. Let the, the equivalent of the embedding algorithm, whatever they called in graph land. Um, so the one with the best results wins. I think so. Yeah.swyx [00:18:26]: Or is this the practical side of me is like, yeah, it's, if it's useful, we don't necessarilyDharmesh [00:18:30]: need to understand it.swyx [00:18:30]: I have, I mean, I'm happy to push back as long as you want. Uh, it's not practical to evaluate like the 10 different options out there because it takes time. It takes people, it takes, you know, resources, right? Set. That's the first thing. Second thing is your evals are typically on small things and some things only work at scale. Yup. Like graphs. Yup.Dharmesh [00:18:46]: Yup. That's, yeah, no, that's fair. And I think this is one of the challenges in terms of implementation of graph databases is that the most common approach that I've seen developers do, I've done it myself, is that, oh, I've got a Postgres database or a MySQL or whatever. I can represent a graph with a very set of tables with a parent child thing or whatever. And that sort of gives me the ability, uh, why would I need anything more than that? And the answer is, well, if you don't need anything more than that, you don't need anything more than that. But there's a high chance that you're sort of missing out on the actual value that, uh, the graph representation gives you. Which is the ability to traverse the graph, uh, efficiently in ways that kind of going through the, uh, traversal in a relational database form, even though structurally you have the data, practically you're not gonna be able to pull it out in, in useful ways. Uh, so you wouldn't like represent a social graph, uh, in, in using that kind of relational table model. It just wouldn't scale. It wouldn't work.swyx [00:19:36]: Uh, yeah. Uh, I think we want to move on to MCP. Yeah. But I just want to, like, just engineering advice. Yeah. Uh, obviously you've, you've, you've run, uh, you've, you've had to do a lot of projects and run a lot of teams. Do you have a general rule for over-engineering or, you know, engineering ahead of time? You know, like, because people, we know premature engineering is the root of all evil. Yep. But also sometimes you just have to. Yep. When do you do it? Yes.Dharmesh [00:19:59]: It's a great question. This is, uh, a question as old as time almost, which is what's the right and wrong levels of abstraction. That's effectively what, uh, we're answering when we're trying to do engineering. I tend to be a pragmatist, right? So here's the thing. Um, lots of times doing something the right way. Yeah. It's like a marginal increased cost in those cases. Just do it the right way. And this is what makes a, uh, a great engineer or a good engineer better than, uh, a not so great one. It's like, okay, all things being equal. If it's going to take you, you know, roughly close to constant time anyway, might as well do it the right way. Like, so do things well, then the question is, okay, well, am I building a framework as the reusable library? To what degree, uh, what am I anticipating in terms of what's going to need to change in this thing? Uh, you know, along what dimension? And then I think like a business person in some ways, like what's the return on calories, right? So, uh, and you look at, um, energy, the expected value of it's like, okay, here are the five possible things that could happen, uh, try to assign probabilities like, okay, well, if there's a 50% chance that we're going to go down this particular path at some day, like, or one of these five things is going to happen and it costs you 10% more to engineer for that. It's basically, it's something that yields a kind of interest compounding value. Um, as you get closer to the time of, of needing that versus having to take on debt, which is when you under engineer it, you're taking on debt. You're going to have to pay off when you do get to that eventuality where something happens. One thing as a pragmatist, uh, so I would rather under engineer something than over engineer it. If I were going to err on the side of something, and here's the reason is that when you under engineer it, uh, yes, you take on tech debt, uh, but the interest rate is relatively known and payoff is very, very possible, right? Which is, oh, I took a shortcut here as a result of which now this thing that should have taken me a week is now going to take me four weeks. Fine. But if that particular thing that you thought might happen, never actually, you never have that use case transpire or just doesn't, it's like, well, you just save yourself time, right? And that has value because you were able to do other things instead of, uh, kind of slightly over-engineering it away, over-engineering it. But there's no perfect answers in art form in terms of, uh, and yeah, we'll, we'll bring kind of this layers of abstraction back on the code generation conversation, which we'll, uh, I think I have later on, butAlessio [00:22:05]: I was going to ask, we can just jump ahead quickly. Yeah. Like, as you think about vibe coding and all that, how does the. Yeah. Percentage of potential usefulness change when I feel like we over-engineering a lot of times it's like the investment in syntax, it's less about the investment in like arc exacting. Yep. Yeah. How does that change your calculus?Dharmesh [00:22:22]: A couple of things, right? One is, um, so, you know, going back to that kind of ROI or a return on calories, kind of calculus or heuristic you think through, it's like, okay, well, what is it going to cost me to put this layer of abstraction above the code that I'm writing now, uh, in anticipating kind of future needs. If the cost of fixing, uh, or doing under engineering right now. Uh, we'll trend towards zero that says, okay, well, I don't have to get it right right now because even if I get it wrong, I'll run the thing for six hours instead of 60 minutes or whatever. It doesn't really matter, right? Like, because that's going to trend towards zero to be able, the ability to refactor a code. Um, and because we're going to not that long from now, we're going to have, you know, large code bases be able to exist, uh, you know, as, as context, uh, for a code generation or a code refactoring, uh, model. So I think it's going to make it, uh, make the case for under engineering, uh, even stronger. Which is why I take on that cost. You just pay the interest when you get there, it's not, um, just go on with your life vibe coded and, uh, come back when you need to. Yeah.Alessio [00:23:18]: Sometimes I feel like there's no decision-making in some things like, uh, today I built a autosave for like our internal notes platform and I literally just ask them cursor. Can you add autosave? Yeah. I don't know if it's over under engineer. Yep. I just vibe coded it. Yep. And I feel like at some point we're going to get to the point where the models kindDharmesh [00:23:36]: of decide where the right line is, but this is where the, like the, in my mind, the danger is, right? So there's two sides to this. One is the cost of kind of development and coding and things like that stuff that, you know, we talk about. But then like in your example, you know, one of the risks that we have is that because adding a feature, uh, like a save or whatever the feature might be to a product as that price tends towards zero, are we going to be less discriminant about what features we add as a result of making more product products more complicated, which has a negative impact on the user and navigate negative impact on the business. Um, and so that's the thing I worry about if it starts to become too easy, are we going to be. Too promiscuous in our, uh, kind of extension, adding product extensions and things like that. It's like, ah, why not add X, Y, Z or whatever back then it was like, oh, we only have so many engineering hours or story points or however you measure things. Uh, that least kept us in check a little bit. Yeah.Alessio [00:24:22]: And then over engineering, you're like, yeah, it's kind of like you're putting that on yourself. Yeah. Like now it's like the models don't understand that if they add too much complexity, it's going to come back to bite them later. Yep. So they just do whatever they want to do. Yeah. And I'm curious where in the workflow that's going to be, where it's like, Hey, this is like the amount of complexity and over-engineering you can do before you got to ask me if we should actually do it versus like do something else.Dharmesh [00:24:45]: So you know, we've already, let's like, we're leaving this, uh, in the code generation world, this kind of compressed, um, cycle time. Right. It's like, okay, we went from auto-complete, uh, in the GitHub co-pilot to like, oh, finish this particular thing and hit tab to a, oh, I sort of know your file or whatever. I can write out a full function to you to now I can like hold a bunch of the context in my head. Uh, so we can do app generation, which we have now with lovable and bolt and repletage. Yeah. Association and other things. So then the question is, okay, well, where does it naturally go from here? So we're going to generate products. Make sense. We might be able to generate platforms as though I want a platform for ERP that does this, whatever. And that includes the API's includes the product and the UI, and all the things that make for a platform. There's no nothing that says we would stop like, okay, can you generate an entire software company someday? Right. Uh, with the platform and the monetization and the go-to-market and the whatever. And you know, that that's interesting to me in terms of, uh, you know, what, when you take it to almost ludicrous levels. of abstract.swyx [00:25:39]: It's like, okay, turn it to 11. You mentioned vibe coding, so I have to, this is a blog post I haven't written, but I'm kind of exploring it. Is the junior engineer dead?Dharmesh [00:25:49]: I don't think so. I think what will happen is that the junior engineer will be able to, if all they're bringing to the table is the fact that they are a junior engineer, then yes, they're likely dead. But hopefully if they can communicate with carbon-based life forms, they can interact with product, if they're willing to talk to customers, they can take their kind of basic understanding of engineering and how kind of software works. I think that has value. So I have a 14-year-old right now who's taking Python programming class, and some people ask me, it's like, why is he learning coding? And my answer is, is because it's not about the syntax, it's not about the coding. What he's learning is like the fundamental thing of like how things work. And there's value in that. I think there's going to be timeless value in systems thinking and abstractions and what that means. And whether functions manifested as math, which he's going to get exposed to regardless, or there are some core primitives to the universe, I think, that the more you understand them, those are what I would kind of think of as like really large dots in your life that will have a higher gravitational pull and value to them that you'll then be able to. So I want him to collect those dots, and he's not resisting. So it's like, okay, while he's still listening to me, I'm going to have him do things that I think will be useful.swyx [00:26:59]: You know, part of one of the pitches that I evaluated for AI engineer is a term. And the term is that maybe the traditional interview path or career path of software engineer goes away, which is because what's the point of lead code? Yeah. And, you know, it actually matters more that you know how to work with AI and to implement the things that you want. Yep.Dharmesh [00:27:16]: That's one of the like interesting things that's happened with generative AI. You know, you go from machine learning and the models and just that underlying form, which is like true engineering, right? Like the actual, what I call real engineering. I don't think of myself as a real engineer, actually. I'm a developer. But now with generative AI. We call it AI and it's obviously got its roots in machine learning, but it just feels like fundamentally different to me. Like you have the vibe. It's like, okay, well, this is just a whole different approach to software development to so many different things. And so I'm wondering now, it's like an AI engineer is like, if you were like to draw the Venn diagram, it's interesting because the cross between like AI things, generative AI and what the tools are capable of, what the models do, and this whole new kind of body of knowledge that we're still building out, it's still very young, intersected with kind of classic engineering, software engineering. Yeah.swyx [00:28:04]: I just described the overlap as it separates out eventually until it's its own thing, but it's starting out as a software. Yeah.Alessio [00:28:11]: That makes sense. So to close the vibe coding loop, the other big hype now is MCPs. Obviously, I would say Cloud Desktop and Cursor are like the two main drivers of MCP usage. I would say my favorite is the Sentry MCP. I can pull in errors and then you can just put the context in Cursor. How do you think about that abstraction layer? Does it feel... Does it feel almost too magical in a way? Do you think it's like you get enough? Because you don't really see how the server itself is then kind of like repackaging theDharmesh [00:28:41]: information for you? I think MCP as a standard is one of the better things that's happened in the world of AI because a standard needed to exist and absent a standard, there was a set of things that just weren't possible. Now, we can argue whether it's the best possible manifestation of a standard or not. Does it do too much? Does it do too little? I get that, but it's just simple enough to both be useful and unobtrusive. It's understandable and adoptable by mere mortals, right? It's not overly complicated. You know, a reasonable engineer can put a stand up an MCP server relatively easily. The thing that has me excited about it is like, so I'm a big believer in multi-agent systems. And so that's going back to our kind of this idea of an atomic agent. So imagine the MCP server, like obviously it calls tools, but the way I think about it, so I'm working on my current passion project is agent.ai. And we'll talk more about that in a little bit. More about the, I think we should, because I think it's interesting not to promote the project at all, but there's some interesting ideas in there. One of which is around, we're going to need a mechanism for, if agents are going to collaborate and be able to delegate, there's going to need to be some form of discovery and we're going to need some standard way. It's like, okay, well, I just need to know what this thing over here is capable of. We're going to need a registry, which Anthropic's working on. I'm sure others will and have been doing directories of, and there's going to be a standard around that too. How do you build out a directory of MCP servers? I think that's going to unlock so many things just because, and we're already starting to see it. So I think MCP or something like it is going to be the next major unlock because it allows systems that don't know about each other, don't need to, it's that kind of decoupling of like Sentry and whatever tools someone else was building. And it's not just about, you know, Cloud Desktop or things like, even on the client side, I think we're going to see very interesting consumers of MCP, MCP clients versus just the chat body kind of things. Like, you know, Cloud Desktop and Cursor and things like that. But yeah, I'm very excited about MCP in that general direction.swyx [00:30:39]: I think the typical cynical developer take, it's like, we have OpenAPI. Yeah. What's the new thing? I don't know if you have a, do you have a quick MCP versus everything else? Yeah.Dharmesh [00:30:49]: So it's, so I like OpenAPI, right? So just a descriptive thing. It's OpenAPI. OpenAPI. Yes, that's what I meant. So it's basically a self-documenting thing. We can do machine-generated, lots of things from that output. It's a structured definition of an API. I get that, love it. But MCPs sort of are kind of use case specific. They're perfect for exactly what we're trying to use them for around LLMs in terms of discovery. It's like, okay, I don't necessarily need to know kind of all this detail. And so right now we have, we'll talk more about like MCP server implementations, but We will? I think, I don't know. Maybe we won't. At least it's in my head. It's like a back processor. But I do think MCP adds value above OpenAPI. It's, yeah, just because it solves this particular thing. And if we had come to the world, which we have, like, it's like, hey, we already have OpenAPI. It's like, if that were good enough for the universe, the universe would have adopted it already. There's a reason why MCP is taking office because marginally adds something that was missing before and doesn't go too far. And so that's why the kind of rate of adoption, you folks have written about this and talked about it. Yeah, why MCP won. Yeah. And it won because the universe decided that this was useful and maybe it gets supplanted by something else. Yeah. And maybe we discover, oh, maybe OpenAPI was good enough the whole time. I doubt that.swyx [00:32:09]: The meta lesson, this is, I mean, he's an investor in DevTools companies. I work in developer experience at DevRel in DevTools companies. Yep. Everyone wants to own the standard. Yeah. I'm sure you guys have tried to launch your own standards. Actually, it's Houseplant known for a standard, you know, obviously inbound marketing. But is there a standard or protocol that you ever tried to push? No.Dharmesh [00:32:30]: And there's a reason for this. Yeah. Is that? And I don't mean, need to mean, speak for the people of HubSpot, but I personally. You kind of do. I'm not smart enough. That's not the, like, I think I have a. You're smart. Not enough for that. I'm much better off understanding the standards that are out there. And I'm more on the composability side. Let's, like, take the pieces of technology that exist out there, combine them in creative, unique ways. And I like to consume standards. I don't like to, and that's not that I don't like to create them. I just don't think I have the, both the raw wattage or the credibility. It's like, okay, well, who the heck is Dharmesh, and why should we adopt a standard he created?swyx [00:33:07]: Yeah, I mean, there are people who don't monetize standards, like OpenTelemetry is a big standard, and LightStep never capitalized on that.Dharmesh [00:33:15]: So, okay, so if I were to do a standard, there's two things that have been in my head in the past. I was one around, a very, very basic one around, I don't even have the domain, I have a domain for everything, for open marketing. Because the issue we had in HubSpot grew up in the marketing space. There we go. There was no standard around data formats and things like that. It doesn't go anywhere. But the other one, and I did not mean to go here, but I'm going to go here. It's called OpenGraph. I know the term was already taken, but it hasn't been used for like 15 years now for its original purpose. But what I think should exist in the world is right now, our information, all of us, nodes are in the social graph at Meta or the professional graph at LinkedIn. Both of which are actually relatively closed in actually very annoying ways. Like very, very closed, right? Especially LinkedIn. Especially LinkedIn. I personally believe that if it's my data, and if I would get utility out of it being open, I should be able to make my data open or publish it in whatever forms that I choose, as long as I have control over it as opt-in. So the idea is around OpenGraph that says, here's a standard, here's a way to publish it. I should be able to go to OpenGraph.org slash Dharmesh dot JSON and get it back. And it's like, here's your stuff, right? And I can choose along the way and people can write to it and I can prove. And there can be an entire system. And if I were to do that, I would do it as a... Like a public benefit, non-profit-y kind of thing, as this is a contribution to society. I wouldn't try to commercialize that. Have you looked at AdProto? What's that? AdProto.swyx [00:34:43]: It's the protocol behind Blue Sky. Okay. My good friend, Dan Abramov, who was the face of React for many, many years, now works there. And he actually did a talk that I can send you, which basically kind of tries to articulate what you just said. But he does, he loves doing these like really great analogies, which I think you'll like. Like, you know, a lot of our data is behind a handle, behind a domain. Yep. So he's like, all right, what if we flip that? What if it was like our handle and then the domain? Yep. So, and that's really like your data should belong to you. Yep. And I should not have to wait 30 days for my Twitter data to export. Yep.Dharmesh [00:35:19]: you should be able to at least be able to automate it or do like, yes, I should be able to plug it into an agentic thing. Yeah. Yes. I think we're... Because so much of our data is... Locked up. I think the trick here isn't that standard. It is getting the normies to care.swyx [00:35:37]: Yeah. Because normies don't care.Dharmesh [00:35:38]: That's true. But building on that, normies don't care. So, you know, privacy is a really hot topic and an easy word to use, but it's not a binary thing. Like there are use cases where, and we make these choices all the time, that I will trade, not all privacy, but I will trade some privacy for some productivity gain or some benefit to me that says, oh, I don't care about that particular data being online if it gives me this in return, or I don't mind sharing this information with this company.Alessio [00:36:02]: If I'm getting, you know, this in return, but that sort of should be my option. I think now with computer use, you can actually automate some of the exports. Yes. Like something we've been doing internally is like everybody exports their LinkedIn connections. Yep. And then internally, we kind of merge them together to see how we can connect our companies to customers or things like that.Dharmesh [00:36:21]: And not to pick on LinkedIn, but since we're talking about it, but they feel strongly enough on the, you know, do not take LinkedIn data that they will block even browser use kind of things or whatever. They go to great, great lengths, even to see patterns of usage. And it says, oh, there's no way you could have, you know, gotten that particular thing or whatever without, and it's, so it's, there's...swyx [00:36:42]: Wasn't there a Supreme Court case that they lost? Yeah.Dharmesh [00:36:45]: So the one they lost was around someone that was scraping public data that was on the public internet. And that particular company had not signed any terms of service or whatever. It's like, oh, I'm just taking data that's on, there was no, and so that's why they won. But now, you know, the question is around, can LinkedIn... I think they can. Like, when you use, as a user, you use LinkedIn, you are signing up for their terms of service. And if they say, well, this kind of use of your LinkedIn account that violates our terms of service, they can shut your account down, right? They can. And they, yeah, so, you know, we don't need to make this a discussion. By the way, I love the company, don't get me wrong. I'm an avid user of the product. You know, I've got... Yeah, I mean, you've got over a million followers on LinkedIn, I think. Yeah, I do. And I've known people there for a long, long time, right? And I have lots of respect. And I understand even where the mindset originally came from of this kind of members-first approach to, you know, a privacy-first. I sort of get that. But sometimes you sort of have to wonder, it's like, okay, well, that was 15, 20 years ago. There's likely some controlled ways to expose some data on some member's behalf and not just completely be a binary. It's like, no, thou shalt not have the data.swyx [00:37:54]: Well, just pay for sales navigator.Alessio [00:37:57]: Before we move to the next layer of instruction, anything else on MCP you mentioned? Let's move back and then I'll tie it back to MCPs.Dharmesh [00:38:05]: So I think the... Open this with agent. Okay, so I'll start with... Here's my kind of running thesis, is that as AI and agents evolve, which they're doing very, very quickly, we're going to look at them more and more. I don't like to anthropomorphize. We'll talk about why this is not that. Less as just like raw tools and more like teammates. They'll still be software. They should self-disclose as being software. I'm totally cool with that. But I think what's going to happen is that in the same way you might collaborate with a team member on Slack or Teams or whatever you use, you can imagine a series of agents that do specific things just like a team member might do, that you can delegate things to. You can collaborate. You can say, hey, can you take a look at this? Can you proofread that? Can you try this? You can... Whatever it happens to be. So I think it is... I will go so far as to say it's inevitable that we're going to have hybrid teams someday. And what I mean by hybrid teams... So back in the day, hybrid teams were, oh, well, you have some full-time employees and some contractors. Then it was like hybrid teams are some people that are in the office and some that are remote. That's the kind of form of hybrid. The next form of hybrid is like the carbon-based life forms and agents and AI and some form of software. So let's say we temporarily stipulate that I'm right about that over some time horizon that eventually we're going to have these kind of digitally hybrid teams. So if that's true, then the question you sort of ask yourself is that then what needs to exist in order for us to get the full value of that new model? It's like, okay, well... You sort of need to... It's like, okay, well, how do I... If I'm building a digital team, like, how do I... Just in the same way, if I'm interviewing for an engineer or a designer or a PM, whatever, it's like, well, that's why we have professional networks, right? It's like, oh, they have a presence on likely LinkedIn. I can go through that semi-structured, structured form, and I can see the experience of whatever, you know, self-disclosed. But, okay, well, agents are going to need that someday. And so I'm like, okay, well, this seems like a thread that's worth pulling on. That says, okay. So I... So agent.ai is out there. And it's LinkedIn for agents. It's LinkedIn for agents. It's a professional network for agents. And the more I pull on that thread, it's like, okay, well, if that's true, like, what happens, right? It's like, oh, well, they have a profile just like anyone else, just like a human would. It's going to be a graph underneath, just like a professional network would be. It's just that... And you can have its, you know, connections and follows, and agents should be able to post. That's maybe how they do release notes. Like, oh, I have this new version. Whatever they decide to post, it should just be able to... Behave as a node on the network of a professional network. As it turns out, the more I think about that and pull on that thread, the more and more things, like, start to make sense to me. So it may be more than just a pure professional network. So my original thought was, okay, well, it's a professional network and agents as they exist out there, which I think there's going to be more and more of, will kind of exist on this network and have the profile. But then, and this is always dangerous, I'm like, okay, I want to see a world where thousands of agents are out there in order for the... Because those digital employees, the digital workers don't exist yet in any meaningful way. And so then I'm like, oh, can I make that easier for, like... And so I have, as one does, it's like, oh, I'll build a low-code platform for building agents. How hard could that be, right? Like, very hard, as it turns out. But it's been fun. So now, agent.ai has 1.3 million users. 3,000 people have actually, you know, built some variation of an agent, sometimes just for their own personal productivity. About 1,000 of which have been published. And the reason this comes back to MCP for me, so imagine that and other networks, since I know agent.ai. So right now, we have an MCP server for agent.ai that exposes all the internally built agents that we have that do, like, super useful things. Like, you know, I have access to a Twitter API that I can subsidize the cost. And I can say, you know, if you're looking to build something for social media, these kinds of things, with a single API key, and it's all completely free right now, I'm funding it. That's a useful way for it to work. And then we have a developer to say, oh, I have this idea. I don't have to worry about open AI. I don't have to worry about, now, you know, this particular model is better. It has access to all the models with one key. And we proxy it kind of behind the scenes. And then expose it. So then we get this kind of community effect, right? That says, oh, well, someone else may have built an agent to do X. Like, I have an agent right now that I built for myself to do domain valuation for website domains because I'm obsessed with domains, right? And, like, there's no efficient market for domains. There's no Zillow for domains right now that tells you, oh, here are what houses in your neighborhood sold for. It's like, well, why doesn't that exist? We should be able to solve that problem. And, yes, you're still guessing. Fine. There should be some simple heuristic. So I built that. It's like, okay, well, let me go look for past transactions. You say, okay, I'm going to type in agent.ai, agent.com, whatever domain. What's it actually worth? I'm looking at buying it. It can go and say, oh, which is what it does. It's like, I'm going to go look at are there any published domain transactions recently that are similar, either use the same word, same top-level domain, whatever it is. And it comes back with an approximate value, and it comes back with its kind of rationale for why it picked the value and comparable transactions. Oh, by the way, this domain sold for published. Okay. So that agent now, let's say, existed on the web, on agent.ai. Then imagine someone else says, oh, you know, I want to build a brand-building agent for startups and entrepreneurs to come up with names for their startup. Like a common problem, every startup is like, ah, I don't know what to call it. And so they type in five random words that kind of define whatever their startup is. And you can do all manner of things, one of which is like, oh, well, I need to find the domain for it. What are possible choices? Now it's like, okay, well, it would be nice to know if there's an aftermarket price for it, if it's listed for sale. Awesome. Then imagine calling this valuation agent. It's like, okay, well, I want to find where the arbitrage is, where the agent valuation tool says this thing is worth $25,000. It's listed on GoDaddy for $5,000. It's close enough. Let's go do that. Right? And that's a kind of composition use case that in my future state. Thousands of agents on the network, all discoverable through something like MCP. And then you as a developer of agents have access to all these kind of Lego building blocks based on what you're trying to solve. Then you blend in orchestration, which is getting better and better with the reasoning models now. Just describe the problem that you have. Now, the next layer that we're all contending with is that how many tools can you actually give an LLM before the LLM breaks? That number used to be like 15 or 20 before you kind of started to vary dramatically. And so that's the thing I'm thinking about now. It's like, okay, if I want to... If I want to expose 1,000 of these agents to a given LLM, obviously I can't give it all 1,000. Is there some intermediate layer that says, based on your prompt, I'm going to make a best guess at which agents might be able to be helpful for this particular thing? Yeah.Alessio [00:44:37]: Yeah, like RAG for tools. Yep. I did build the Latent Space Researcher on agent.ai. Okay. Nice. Yeah, that seems like, you know, then there's going to be a Latent Space Scheduler. And then once I schedule a research, you know, and you build all of these things. By the way, my apologies for the user experience. You realize I'm an engineer. It's pretty good.swyx [00:44:56]: I think it's a normie-friendly thing. Yeah. That's your magic. HubSpot does the same thing.Alessio [00:45:01]: Yeah, just to like quickly run through it. You can basically create all these different steps. And these steps are like, you know, static versus like variable-driven things. How did you decide between this kind of like low-code-ish versus doing, you know, low-code with code backend versus like not exposing that at all? Any fun design decisions? Yeah. And this is, I think...Dharmesh [00:45:22]: I think lots of people are likely sitting in exactly my position right now, coming through the choosing between deterministic. Like if you're like in a business or building, you know, some sort of agentic thing, do you decide to do a deterministic thing? Or do you go non-deterministic and just let the alum handle it, right, with the reasoning models? The original idea and the reason I took the low-code stepwise, a very deterministic approach. A, the reasoning models did not exist at that time. That's thing number one. Thing number two is if you can get... If you know in your head... If you know in your head what the actual steps are to accomplish whatever goal, why would you leave that to chance? There's no upside. There's literally no upside. Just tell me, like, what steps do you need executed? So right now what I'm playing with... So one thing we haven't talked about yet, and people don't talk about UI and agents. Right now, the primary interaction model... Or they don't talk enough about it. I know some people have. But it's like, okay, so we're used to the chatbot back and forth. Fine. I get that. But I think we're going to move to a blend of... Some of those things are going to be synchronous as they are now. But some are going to be... Some are going to be async. It's just going to put it in a queue, just like... And this goes back to my... Man, I talk fast. But I have this... I only have one other speed. It's even faster. So imagine it's like if you're working... So back to my, oh, we're going to have these hybrid digital teams. Like, you would not go to a co-worker and say, I'm going to ask you to do this thing, and then sit there and wait for them to go do it. Like, that's not how the world works. So it's nice to be able to just, like, hand something off to someone. It's like, okay, well, maybe I expect a response in an hour or a day or something like that.Dharmesh [00:46:52]: In terms of when things need to happen. So the UI around agents. So if you look at the output of agent.ai agents right now, they are the simplest possible manifestation of a UI, right? That says, oh, we have inputs of, like, four different types. Like, we've got a dropdown, we've got multi-select, all the things. It's like back in HTML, the original HTML 1.0 days, right? Like, you're the smallest possible set of primitives for a UI. And it just says, okay, because we need to collect some information from the user, and then we go do steps and do things. And generate some output in HTML or markup are the two primary examples. So the thing I've been asking myself, if I keep going down that path. So people ask me, I get requests all the time. It's like, oh, can you make the UI sort of boring? I need to be able to do this, right? And if I keep pulling on that, it's like, okay, well, now I've built an entire UI builder thing. Where does this end? And so I think the right answer, and this is what I'm going to be backcoding once I get done here, is around injecting a code generation UI generation into, the agent.ai flow, right? As a builder, you're like, okay, I'm going to describe the thing that I want, much like you would do in a vibe coding world. But instead of generating the entire app, it's going to generate the UI that exists at some point in either that deterministic flow or something like that. It says, oh, here's the thing I'm trying to do. Go generate the UI for me. And I can go through some iterations. And what I think of it as a, so it's like, I'm going to generate the code, generate the code, tweak it, go through this kind of prompt style, like we do with vibe coding now. And at some point, I'm going to be happy with it. And I'm going to hit save. And that's going to become the action in that particular step. It's like a caching of the generated code that I can then, like incur any inference time costs. It's just the actual code at that point.Alessio [00:48:29]: Yeah, I invested in a company called E2B, which does code sandbox. And they powered the LM arena web arena. So it's basically the, just like you do LMS, like text to text, they do the same for like UI generation. So if you're asking a model, how do you do it? But yeah, I think that's kind of where.Dharmesh [00:48:45]: That's the thing I'm really fascinated by. So the early LLM, you know, we're understandably, but laughably bad at simple arithmetic, right? That's the thing like my wife, Normies would ask us, like, you call this AI, like it can't, my son would be like, it's just stupid. It can't even do like simple arithmetic. And then like we've discovered over time that, and there's a reason for this, right? It's like, it's a large, there's, you know, the word language is in there for a reason in terms of what it's been trained on. It's not meant to do math, but now it's like, okay, well, the fact that it has access to a Python interpreter that I can actually call at runtime, that solves an entire body of problems that it wasn't trained to do. And it's basically a form of delegation. And so the thought that's kind of rattling around in my head is that that's great. So it's, it's like took the arithmetic problem and took it first. Now, like anything that's solvable through a relatively concrete Python program, it's able to do a bunch of things that I couldn't do before. Can we get to the same place with UI? I don't know what the future of UI looks like in a agentic AI world, but maybe let the LLM handle it, but not in the classic sense. Maybe it generates it on the fly, or maybe we go through some iterations and hit cache or something like that. So it's a little bit more predictable. Uh, I don't know, but yeah.Alessio [00:49:48]: And especially when is the human supposed to intervene? So, especially if you're composing them, most of them should not have a UI because then they're just web hooking to somewhere else. I just want to touch back. I don't know if you have more comments on this.swyx [00:50:01]: I was just going to ask when you, you said you got, you're going to go back to code. What

In this episode, we explore the power of dreaming—how it's the most affordable and transformative form of entertainment. As kids, we dreamed without limits because we were closest to God and hadn't yet adopted the limitations of the world. We'll dive into how imagination activates our reticular activating system (RAS), helping us see opportunities that were always there. Tune in as we challenge impossibility thinking and reclaim the power of dreaming.You Got This,Ryan

Rob Pizzola and the team from The Hammer Betting Network dive deep into the latest news and drama making waves on Gambling Twitter. From controversial takes to unexpected betting strategies, we're breaking down all the must-know moments from the week. In today's show we discuss the insane takes from March Madness, the sports betting influencer bracket, air our grievances and much more. Whether you're here for the insights or just the entertainment, don't miss this lively discussion on the hottest topics in the betting community on Circles Back, the latest show on The Hammer Betting Network, part of Circles Off and proudly presented by Underdog.

Hour 2 1:12 - Take Command Segment: How Important is RAS in the NFL Scouting Process? 17:45 - Are the Steelers the Only Option for Aaron Rodgers? 28:01 - Real Things: Noah Brown

  The other night I thought I heard something on T.V. and what I heard wasn't at all what they had said. It showed me what my brain was tuning into and what it was looking for and I had to share it with you. I believe that if we share our experiences with one another, it helps us to stay connected and feel less alone. That's all I'll say here, except for please listen and share!

Are GLP-1 medications the future of weight loss? On this week's episode, WHOOP Global Head of Human Performance Principal Scientist, Kristen Holmes, sits down with Dr. Greg Grosicki, WHOOP Senior Research Scientist, to discuss all things GLP-1 and GLP-1 Receptor Agonists (RAs). Dr. Greg Grosicki is a member of the Performance Science team at WHOOP, an accomplished IRONMAN athlete, and holds a PhD in Human Bioenergetics and a Masters Degree in Data Science. Greg's background focusses on exercise physiology and aims to help people live longer and healthier in order to perform at their peak. Greg recently led a study at WHOOP that looked into the effects of GLP-1 RAs on heart health and responses in health behaviors. Kristen and Greg discuss Greg's journey to WHOOP and his research background (1:32), using exercise physiology to help people live longer and healthier (02:52), and how research at WHOOP will help you live better (06:07). Greg dives into the WHOOP GLP-1 study (10:54), GLP-1 medications access (20:48), and what people should expect from a GLP-1RA (23:09). Kristen and Greg break down GLP-1 RAs, their relationships with food addiction (24:30), Hollywood (26:16), and the idea of microdosing drugs like ozempic (27:10). The episode continues, providing an understanding for the importance of studying GLP-1 and using WHOOP as a tool for data collection (28:20), the study's results (32:56), and identifying research bias (35:55). Kristen and Greg discuss the relationship of GLP-1 and cardiovascular health (39:07), the impact of exercise on cardiovascular health (40:28) and maintaining muscle tissue when using GLP-1RAs (43:42). Read the study here: Heart and health behavior responses to GLP-1 receptor agonists: a 12-wk study using wearable technology and causal inferenceSupport the showFollow WHOOPwww.whoop.comTrial WHOOP for FreeInstagramTikTokXFacebookLinkedIn Follow Will AhmedInstagramXLinkedIn Follow Kristen Holmes Instagram LinkedIn

Rob Pizzola and the team from The Hammer Betting Network dive deep into the latest news and drama making waves on Gambling Twitter. From controversial takes to unexpected betting strategies, we're breaking down all the must-know moments from the week but we're doing it with a different cast. Rob is joined as usual by Kirk Evans but has special guest JOEY KNISH also joining in studio. Today's show discusses GRP's decision to go tout, Matt Zylbert cashing in for showing his $45.60 bet, the horrible week that was for Steve Fezzik and so much more that you do now want to miss. Whether you're here for the insights or just the entertainment, don't miss this lively discussion on the hottest topics in the betting community on Circles Back, the latest show on The Hammer Betting Network, part of Circles Off and proudly presented by Underdog.

MAR10 Day is a great day for a colonoscopy, flooding in the basement, and movies like Mickey 17. Lots of fun stuff including tips on finding an art style over time. A college dorm story about root beer and RAs. And we clarify a Culkin brother mix-up. Hosted on Acast. See acast.com/privacy for more information.

The FiltrateJoel TopfSwapnil HiremathAC GomezSopia AmbrusoNayan AroraSpecial Guests Michelle Rheault, Director, Division of Pediatric Nephrology, Professor of MedicineTiffany Caza, Nephropathologist, Scientist and self-described Freely Filtered fan girlEditing bySimon Topf and Sophia AmbrusoShow Notes10. Healthcare Cyberattacks9. ApoE in C3 glomerulonephropathy8. Workforce woes in Adult and Pediatric Nephrology7. Hyponatremia correction meta-analysis6. Microvascular inflammation increases risk of graft loss - in all of its forms5. Xenotransplantation4. KDIGO CKD Guidelines3. Hypertension control trials (ESPRIT, BPROAD)2. The Renaissance of IgAN: IgAN treatment trials1. FLOW: GLP-1 RAs in CKD