Podcasts about Spontaneous

Spontaneous short episodes recorded Off The Cuff from the heart and life of Matt Knoll.

Fluent Fiction - Dutch: A Spontaneous Summer Stroll Through Amsterdam's Dam Square Find the full episode transcript, vocabulary words, and more:fluentfiction.com/nl/episode/2025-06-15-22-34-02-nl Story Transcript:Nl: Dam Square gonst van de mensen.En: Dam Square buzzes with people.Nl: Het is een prachtige zomerdag.En: It is a beautiful summer day.Nl: De zon straalt fel en er loopt een briesje over het plein.En: The sun shines brightly and a breeze wafts over the square.Nl: Gedreven door de drukte en kleur van de markt, slentert Bram langs de kraampjes.En: Driven by the hustle and color of the market, Bram strolls past the stalls.Nl: Sanne loopt naast hem, met de tas stevig in haar hand en een lijst in haar hoofd.En: Sanne walks beside him, with her bag firmly in hand and a list in her head.Nl: "Bram, vergeet niet dat we een budget hebben," waarschuwt Sanne.En: "Bram, don't forget that we have a budget," warns Sanne.Nl: Ze kijkt sceptisch naar de portemonnee in zijn achterzak.En: She looks skeptically at the wallet in his back pocket.Nl: Ze moeten een cadeau voor Brams moeder vinden en hebben niet veel tijd.En: They need to find a gift for Bram's mother and don't have much time.Nl: Bram knikt afwezig.En: Bram nods absentmindedly.Nl: Zijn ogen dwalen af naar een straatartiest die een groep mensen boeit met zijn acrobatiek.En: His eyes wander to a street performer captivating a group of people with his acrobatics.Nl: Bram kan het niet laten: hij voelt de drang om dichterbij te gaan kijken.En: Bram can't help himself; he feels the urge to take a closer look.Nl: "Kom op, Sanne.En: "Come on, Sanne.Nl: Laten we even kijken!"En: Let's have a look!"Nl: roept hij enthousiast.En: he calls out enthusiastically.Nl: Sanne zucht, maar ze volgt hem.En: Sanne sighs but follows him.Nl: De artiest maakt indruk met zijn luisterrijke trucjes, maar Bram's aandacht is al snel weer gefocust op een rij kleurrijke kraampjes langs de kant.En: The performer impresses with his splendid tricks, but Bram's attention is soon drawn to a row of colorful stalls on the side.Nl: Één kraam trekt zijn aandacht met sprankelende sieraden in de zon.En: One stall catches his eye with sparkling jewelry in the sun.Nl: "Misschien is dit iets," oppert Bram.En: "Maybe this is something," suggests Bram.Nl: Sanne schuifelt naar de kraam, haar interesse gewekt.En: Sanne shuffles towards the stall, her interest piqued.Nl: De juwelen lijken handgemaakt.En: The jewels look handmade.Nl: Ze zijn uniek en prachtig.En: They are unique and beautiful.Nl: Bram grijpt een glinsterende halsketting.En: Bram grabs a glittering necklace.Nl: "Dit is het!"En: "This is it!"Nl: roept hij.En: he exclaims.Nl: "Dit is perfect voor mama."En: "This is perfect for mom."Nl: Zijn ogen stralen als hij Sanne aankijkt voor goedkeuring.En: His eyes shine as he looks at Sanne for approval.Nl: Sanne kijkt even peinzend maar knikt dan goedkeurend.En: Sanne looks contemplatively for a moment but then nods approvingly.Nl: De prijs is redelijk en past binnen hun budget.En: The price is reasonable and fits within their budget.Nl: Met het cadeau in de hand verdwijnen de zorgen en haast.En: With the gift in hand, the worries and rush disappear.Nl: Ze wandelen weg van de kraam, beiden opgelucht en voldaan.En: They walk away from the stall, both relieved and satisfied.Nl: Terwijl ze de drukte van de Dam Square verlaten, glimlacht Bram.En: As they leave the bustle of Dam Square, Bram smiles.Nl: "We zijn op tijd klaar en alles onder budget," lacht Sanne, die nu ook ontspant.En: "We're done on time and everything under budget," laughs Sanne, now also relaxed.Nl: Het blijkt dat soms een beetje spontaniteit nodig is om iets bijzonders te vinden.En: It turns out that sometimes a bit of spontaneity is needed to find something special.Nl: Bram leert dat focus belangrijk is, en Sanne ontdekt de vreugde van avontuur.En: Bram learns that focus is important, and Sanne discovers the joy of adventure.Nl: Ze lopen samen, de drukte achterlatend, nog steeds in de energie van de zomermarkt op de Dam.En: They walk together, leaving the hustle and bustle behind, still filled with the energy of the summer market at the Dam. Vocabulary Words:buzzes: gonstbreeze: briesjewafts: looptstalls: kraampjesfirmly: stevigskeptically: sceptischwallet: portemonneeabsentmindedly: afwezigstreet performer: straatartiestcaptivating: boeitacrobatics: acrobatiekurge: drangenthusiastically: enthousiastsighs: zuchtsplendid: luisterrijkedrawn: gefocusdsparkling: sprankelendesuggests: oppertpiqued: gewektshuffles: schuifeltglittering: glinsterendeapproval: goedkeuringcontemplatively: peinzendreasonable: redelijkrelieved: opgeluchtrush: haastspontaneity: spontaniteitfocus: focusadventure: avontuurhustle: drukte

Spontaneous short episodes recorded Off The Cuff from the heart and life of Matt Knoll.

Dr. Holly Everett's work helps us better understand roadside memorials and other public expressions of remembrance. Her 1998 master's thesis, “Crossroads: Roadside Accident Memorials in and around Austin, Texas,” examines 35 memorials, exploring how they're constructed and the cultural meanings they convey. What is the intent of a roadside memorial? Is it meant to be temporary or permanent? Are these markers legal? Who builds them, and what does that process look like? How do roadside memorials compare to spontaneous large-scale public commemorations of grief? Dr. Everett offers insight into these everyday and deeply meaningful spaces of mourning. After learning more about them, you'll never look at them the same.

Recently, sophisticated myelographic techniques to precisely subtype and localize CSF leaks have been developed and refined. These techniques improve the detection of various types of CSF leaks thereby enabling targeted therapies. In this episode, Katie Grouse, MD, FAAN, speaks with Ajay A. Madhavan, MD, author of the article “Radiographic Evaluation of Spontaneous Intracranial Hypotension” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Madhavan is assistant professor of radiology at the Mayo Clinic in Rochester, Minnesota. Additional Resources Read the article: Radiographic Evaluation of Spontaneous Intracranial Hypotension Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Full episode transcript available here Dr Jones:  This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Grouse:  This is Dr Katie Grouse. Today I'm interviewing Dr Ajay Madhavan about his article on Radiographic Evaluation of Spontaneous Intracranial Hypotension, which he wrote with Dr Levi Chazen. This article appears in the June 2025 Continuum issue on disorders of CSF dynamics. Welcome to the podcast, and please introduce yourself to our audience. Dr Madhavan:  Hi, thanks a lot, Katie. Yeah, so I'm Ajay Madhaven. I'm a neuroradiologist at the Mayo Clinic in Rochester, Minnesota. I did all my training here, so, I've been here for a long time. And I have a lot of interest in spinal CSF leaks, and I do a lot of that work. And so I'm really excited to be talking about this article with you. Dr Grouse:  I'm really excited too. And in fact, it's such a pleasure to have you here talking today on this topic. I know a lot's changed in this field, and I'm sure many of our listeners are really interested in learning about the developments and imaging techniques to improve detection and treatment of CSF leaks, especially since maybe we've learned about this in training. I want to start by asking you what you think is the most important takeaway from your article. Dr Madhavan:  Yeah, that's a great question. I think---and you kind of already alluded to it---I think the main thing is, I hope people recognize that this field has really changed a lot in the last five to ten years, through a lot of multi-institutional collaboration and also collaboration between different specialties. We've learned a lot about different types of spinal CSF leaks, how we can recognize the disease, particularly the types of myelography that we need to be using to accurately localize and treat these leaks. Those are the things that have really evolved in the last five to ten years, and they've really helped us improve these patients' lives. Dr Grouse:  Can you remind us of the different common types of spinal leaks that can cause spontaneous intracranial hypotension? Dr Madhavan:  Yeah, so there are a number of different spinal CSF leaks, types, and I would say the three most common ones that really most people should try to be aware of and cognizant of are: first, ventral dural tears. So those are, like, just physical holes in the dura. And they're usually caused by little bone spurs that come from the vertebral columns. So, they're often patients who have some degenerative changes in their spine. And those are really very common. Another type of spinal CSF leak that we commonly see is a lateral dural tear. So that's like the same thing in a slightly different location. So instead of being in the front, it's off to the side of the dura laterally. And so, it's also just a hole in the dura. And then the third and most recently discovered type of spinal CSF leak is a CSF-venous fistula. So those are direct connections between the subarachnoid space and little paraspinal vein. And it took us a long time to even realize that this was a real pathology. But now that it's been recognized, we've found that this is actually quite common. So those three types of leaks are probably the three most common that we see. And there's certainly others out there, but I would say over 90% of them fall into one of those three categories. Dr Grouse:  That's a great review, thank you. Just as another quick review, as we talk more about this topic, can you remind us of some of the most common or typical brain imaging findings that you'll see in cases of spontaneous intracranial hypotension? Dr Madhavan:  Yeah, absolutely. So, when you do a brain MRI in a patient who has spontaneous intracranial hypotension, you will usually, though not always, see typical brain MRI abnormalities. And I kind of think of those as falling into three different categories. So, the first one I think of is dural enhancement or thickening. So that's enlargement or engorgement of the dura, the pachymeninges, and enhancement on postgadolinium imaging. So, that's kind of the first category. The second is that, when you lose spinal fluid volume, other things often expand to take up the space. So, for example, you can get distension or enlargement of the dural venous sinuses, and sometimes you can also get subdural food collections or hematomas. They can arise spontaneously. And I kind of think of those as, you know, you, you've lost the cerebrospinal fluid volume and something else is kind of filling up the space. And then the third category is called brain sagging. And that's a constellation of findings where the posterior fossa structures and the pituitary gland in the cell have become abnormal because you've lost the fluid that normally cushions those structures and causes them to float up. For example, the brain stem will sag down, the distance between the mammillary body and the ponds may become reduced. The suprasellar cistern space may be reduced such that the optic chiasm becomes very close to the pituitary gland, and the prepontine cistern may also become reduced in size. And there are various measurements that can be used to determine whether something is subtly abnormal. But just generally speaking, those are really the three categories of brain MRI abnormalities you'll see. Dr Grouse:  That was a great review. And of course, I think in many times when we are thinking about or suspecting this diagnosis, we may be lucky to find those imaging findings to reinforce a diagnosis. Because as it turns out, after reading your article, I was really surprised to find out that in as many as 19% of cases we actually see normal brain imaging, which really was a surprise to me, I have to say. And I think that this really encompasses why spontaneous intercranial hypotension is such a difficult diagnosis to make. I think a lot of us struggle with how far to take the workup when, you know, spontaneous intercranial hypotension is clinically suspected, but multiple imaging studies are normal. Do you have any guidance on how to approach these more difficult cases? Dr Madhavan:  So, that's a really good question. And you know, it's- as you can imagine, that's a topic that comes up in most meetings where people discuss this, and it's been a continued challenge. And so, like you said, about 19 or 20% of patients who have this disease can have a, a normal brain MRI. And we've tried to do some work to figure out why that is and how we can identify patients who still have the disease. And I can just provide, I guess, some tips that have helped me in my clinical practice. One thing is, if I ever see a patient with a normal brain MRI where this disease is clinically suspected---for example, maybe they have orthostatic headaches or other very typical symptoms and we don't know why, but their brain MRI is normal---the first thing I do is I try to look back at their old imaging. So many times, these patients who present to us at Mayo, who, when we do their MRI scan here, their brain MRI looks normal… if you really look back at imaging that they've had done elsewhere---maybe even two to three years prior---at the time their symptoms started, they actually had some abnormalities. So, I might see that a patient, two years ago, had dural enhancement that spontaneously resolved; but now they still have symptoms of SIH and they may still have a CSF leak that we can find and treat, but their brain MRI has, for whatever reason, normalized. So, I always start by looking back at old imaging, and I found that to be very helpful. The other thing is, if you see a patient with a normal brain MRI, it's also important to look at their spine MRI because that can provide clues that might suggest that they could still have a spinal CSF leak. And the two things I look for on the spine MRI: one, if there's any extradural CSF. So, spinal fluid outside of where it's supposed to be within the confines of the subarachnoid space. And you know, really, if you see extradural CSF, you know they probably have a spinal fluid leak somewhere. Even if their brain MRI is normal, that just gives you the information that there is a dural tear probably somewhere. And so, in those patients we'll definitely still proceed to myelography or other testing, even if they have a normal brain MRI. And then the last thing I look for is whether or not they have prominent meningeal diverticula. Patients with CSF venous fistulas almost always have one or more prominent diverticula on their spine along the nerve root sleeves. And that's probably because most of these fistulas come from nerve root sleeve diverticula. We don't completely understand the pathogenesis of CSF venous fistulas, but they're clearly associated with meningeal diverticula. So, if I see a patient who has a normal brain MRI, but I see on their spine MRI that they have many meningeal diverticula that are relatively prominent, that makes me more inclined to be a little bit more aggressive in doing myelography to find a CSF leak. And then I look at other demographic features, too. So, for example, elevated BMI and older age are associated with CSF venous fistulas. So, that can help you determine whether or not it's warranted to go on to more advanced imaging, too. So those are all just a variety of different things that we've used to help us. Dr Grouse:  Thank you for sharing that. I wanted to go on to say that, you know, reading your article, of course, as you mentioned, you alluded to the fact there's lots of new imaging modalities out there. It was very illuminating and just an excellent resource for the options that exist and when they're useful. You did a great job summarizing it. And I encourage our readers to check out your article, to refresh themselves, update themselves on what's happened in this space. And of course, we can't summarize them all today, but I was wondering if you could possibly walk us through a hypothetical case of a patient who comes in with a history very suspicious for SIH? How would you approach this patient? Say you have gotten imaging that suggested that there is a spinal fluid leak and now you have to figure out where it is. Dr Madhavan:  Yeah. So, you know, I think the most typical scenario it'll be a patient who has been seen by one of my excellent neurology colleagues and they've done a brain MRI and they've made the diagnosis through a combination of clinical information and brain MRI finding. And then the next thing we'll do always is, we'll obtain a spine MRI. So, I think of the purpose of the spine MRI as to determine what type of spinal fluid leak they have. On the spine MRI, if you see extradural CSF, those patients essentially always will have a dural tear. And it may be a ventral dural tear or a lateral dural tear. But if you see extradural CSF, that is pretty much what they have. And conversely, if you don't see extradural CSF---if you just see, for example, many meningeal diverticula, but you don't see anything else particularly abnormal---most of those patients have a CSF venous fistula, just common things being common. So I use the spine MRI to determine what type of leak they have. And then the next thing I think about is, okay, I'm going to do a myelogram on this patient. How do I want to position them? Because it turns out that positioning is probably the most important factor for finding these spinal fluid leaks. You have to have the patient positioned correctly to find the leak that you're trying to localize. And so, if I suspect they have a ventral dural tear, I will always position those patients prone for their myelogram. And I might do one of many different types of myelograms. And, you know, the article talks about things like digital subtraction myelography and dynamic CT myelography. And you can find any of these leaks with any of those techniques, but you just have to have the patient positioned correctly. So, if I think I have a ventral dural tear, I'll put them prone for the myelogram. If I think they have a lateral dural tear, I'll put them in the cubitus position for the myelogram. And also, if they- if I think they have a CSF-venous fistula, I'll also put them in the decubitus position. Obviously if you're putting them in the decubitus position, you have to decide whether it's going to be left or right side down. So that may require a two-day exam. Sometimes you don't have to; in many cases, we're able to just do everything in one day. But those are all the different factors I think about when I'm trying to determine how I'm going to work those patients up further. So, I really use the spine MRI chiefly to think about what type of leak they're going to have and how I'm going to plan the myelogram. Dr Grouse:  That's really great. And it's, I think, really nice to emphasize how much the positioning matters in all this, which I think is not something we've been classically taught as far as the diagnosis of spinal leaks. Another thing I'm really interested in your opinion on is, you talked a lot about how to optimize and what can make you successful at diagnosis. I'm curious what you think one of the easiest mistakes to make or, you know, that we should hopefully avoid when treating patients with this disease. Dr Madhavan:  Yeah. And I think, you know, one other thing that's been discussed a lot in this topic… you know, we've talked about the patients with a normal brain MRI. Another barrier or challenge particularly with CSF-venous fistulas is, sometimes they can be very subtle on imaging. So, it's not always you see it very definitive CSF-venous fistula where you can say, like, there's no question, that's a fistula. There are many times where we do a good-quality myelogram and we see something that looks, like, possible for a CSF venous fistula, or probable. If I had to put a number on it, maybe there's a 50 to 70% chance of real. So, in those cases, we end up wondering, like, should we treat this suspected leak? And I think one common mistake  or one thing that needs to be looked at further is, how do we handle these patients where we don't know whether the fistula is real or not? That's usually something where I will have a discussion with the patient, and I'm usually just very upfront with him about my interpretation of the imaging. I'll just tell them, we did a good-quality myelogram. You did a great job. We got good images. I don't see anything definitive, but I see this thing that I think has maybe a 60% chance of being real. And then I'll confer with one of my neurology colleagues and we'll decide whether it's worth treating that or not. And we'll just be very upfront with a patient about whether- about the likelihood of its success and what their long-term prognosis is. And oftentimes we let them make the decision. But I think that remains to be one of the big challenges is, how do we treat these patients who have suspected leaks that are not definitive on imaging. Dr Grouse:  That sounds absolutely like an important area where there can be problems, so I appreciate that insight. I'm interested what you think in your article would come as the biggest surprise to our listeners who may not have kept up as much with all of the changes that have happened in recent years? Dr Madhavan:  One of the things that was certainly, at least, a surprise to me as I was going through my training and learning about this topic is how diverse myelography has really become. You know, when I was a radiology resident, I learned about myelography as this thing that we've been doing for 30 to 40 years. And historically we've used myelograms just to look for degenerative changes: disc bulges, you know, disc herniations and things like that. Now that MRI is more prevalent, we don't use it as much, but it has turned out that it has a very big role in patients with spinal fluid leaks. Furthermore, something that I've learned is just how diverse these different types of myelograms have become. It used to kind of be just that a myelogram is a myelogram is a myelogram, but now we have different types of positioning, different types of equipment that we use. We vary the timing between contrast injection and imaging to optimize success for finding spinal fluid leaks. So, I think many times I talk to people who may not be as familiar with this field and they're surprised at just how diverse that has become and how sophisticated some of the various myelographic techniques have become and how much that really makes a difference in being able to accurately diagnose these patients. Dr Grouse:  Well, I can say it was a surprise to me. Even as someone who does treat quite a few patients with this condition, I was surprised to see the breadth of different options that have become available. And then kind of a follow-up to that, what do you think the current area of controversy is in this area of diagnosis and treatment? Dr Madhavan:  The biggest ones are ones you've sort of already alluded to. So, one big one is, how far do we go in patients who have a normal brain MRI who still have a clinical suspicion of the disease? And sometimes it's really hard, because sometimes you will find patients who clinically have a very strong case for having spontaneous intracranial hypotension. You look at them, they have very acute-onset orthostatic headaches. There's no better explanation for their symptoms that we know of. And it's hard to know what to do with those patients, because some of them want to continue to undergo diagnostic workup, but you can only do so many myelograms and you can only do so much with this diagnostic workup that requires some radiation dose before it becomes very challenging. That's a major point of just, I guess, ongoing research as to what can we do better for that subset of patients. Fortunately, it's not all of them, it's a subset of them, but I think we could help those patients better in the future as we learn more about the disease. So that's one. And the other one is treating these equivocal findings, like I discussed.  And where should our threshold be to treat a patient, and what type of treatment should we do in patients where we don't know whether a leak is real? Should we just do a very noninvasive- relatively noninvasive blood patch? Do we do an embolization where we're leaving a foreign body there? Is it worth sending those patients to surgery? Those are all unanswered questions and things that continue to spark ongoing debate. Dr Grouse:  Do you think that there's going to be any new big breakthroughs, or even, do you know of any big developments on the horizon that we should be keeping our eyes out for? Dr Madhavan:  You know, I think for me the biggest thing is, imaging is dramatically improving. We talked a little bit about photon counting detector CT in our article, and that's one of the newest and best techniques for imaging these patients because it has very, very high resolution, it has a lower radiation dose, it has allowed us to find leaks that we were not able to find before. And there are other high-resolution modalities that are emerging and becoming more accessible to things like cone beam CT which we do in addition to digital subtraction myelography. And on top of that, we've started to use AI-based tools to make images look a lot better. So, there are various AI algorithms that have come out that allow us to remove artifacts from imaging. They help us image patients with a bigger body habitus better without running into a lot of imaging artifacts. They help us reduce noise in imaging. They can just give us better-quality images and aid us in the diagnosis. For me as a radiologist, those are some of the most exciting things. We're finding less invasive ways with less radiation to better diagnose these patients with just better-quality imaging. Dr Grouse:  Well, that is definitely something to be excited about. So, I just want to thank you so much for talking with us today. It's been such an interesting, informative discussion and a real privilege to talk with you about this important topic. Dr Madhavan:  Yeah, thanks so much. I really appreciate the time to talk with you, and I look forward to seeing the article out there and hopefully getting some interesting questions. Dr Grouse:  Again, today I've been interviewing Dr Ajay Madhavan about his article on Radiographic Evaluation of Spontaneous Intracranial Hypotension, which he wrote with Dr Levi Chasen. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Three Ideas to Bring Your Mind to the Concept That You Have a Magic Lamp in Your Mind Imagine a magic lamp in your mind, like the Genie who grants you three wishes. These wishes can help you: Create your own economy. Chase and achieve your dreams. Bring fun back into your life and spice it up with serendipity.   Action Steps Write it down: Use a notebook, journal, or any physical writing apparatus (avoid typing on PDAs). Write out your: Dreams Ideas of fun Ways to incorporate serendipity into your life. Create visual inspiration: Make vision boards or a photo book. Collect images from: Magazines Websites Your own photos Include: Fun ideas Your dreams Spontaneous activities like baseball games, swimming holes, sailing, hiking nearby, etc. Act the part: Pretend you already have the goal. Take small steps every day to train your mind that your dream is real and on its way. Example: If your dream is to buy a house: Start visiting open houses. Talk to real estate agents about: PMI Closing costs You don't need to share your financial situation—just let them know you plan to buy in a specific neighborhood.     PROSPERITY and ABUNDANCE KRIYA KUNDALINI YOGA : FEEL YOUR ABUNDANCE. KID FRIENDLY YOGA!  Remember to use an orange https://youtu.be/jRegtSKAZDI?si=wAKsXcr8BKTqCXkJ   Fine Wine & Spirits TEQUILLA for sipping NOT margaritas Typical flavors of Tequilla for food pairing: Blanco - unaged or slightly, in neutral oak.  Pair with fish, cheese, light meals such as shrimp salad.  Reposado means rested - it is aged in barrels from a few months to two years.. pair with Mexican food..easy. Anejo- smokey and smooth- grilled meats on the barbeque.. portabello mushrooms, corn on the cob.. big flavors so barbeque flavors are the perfect match. A rare fine Tequilla is available from Zacatecas, Casa Endemica. Organic and Sustainable farmed.    FURTHER RESOURCES: Dan Ison VNS : (YOUR) VERY NEXT STEP Dan Ison financialguardiandan@gmail.com Tequila Exhibit Branigan Cultural Center exhibit: Alienate a Tequila https://lascruces.gov/arts-and-leisure/museums/branigan-cultural-center/ Collier, Robert: The MASTER CODE to ABUNDANCE and ACHIEVEMENT   CONTACT Valerie Hail valerie@allinourminds.com www.allinourminds.com                    

In this spontaneous SPC episode, we dive deep into a wide-ranging conversation filled with mind-bending ideas and paranormal intrigue. These special episodes are where we unload everything we've been exploring lately—when there's too much to talk about for just one topic.We discuss Hemi-Sync meditations, the strange intersections of quantum mechanics and consciousness, and the ongoing evolution of Isaac's unique abilities, including his latest experiments with energy manipulation.From personal meditation breakthroughs to wild theories in quantum physics, this episode also features compelling stories about alien encounters, skinwalkers, and other unexplained phenomena that continue to challenge what we think we know.Whether you're here for the science, the supernatural, or the strange, Episode 8 offers a raw, unscripted look into the many realms we've been exploring.Topics Of EpisodeHere's a list of places and topics discussed in the episode:Hemi-sync meditation experiencesParanormal investigation at the parkEnergy manipulation and healing experimentsQuantum physics and multiverse theoriesSensory deprivation meditation techniquePast life regressionAlien encounter story Skin walker legend in AfghanistanSpiritual awakening experiencesBlack and white hole energy conceptParanormal conventions and dreamsSwamp and water-related visionsAlligator storiesUpcoming podcast interviewsPersonal paranormal abilities developmentLovin' the intro and outro music?"Swamp Witch”Our other intro Music: "Stacy Dahl" by MaudlinWant to hear more from Maudlin? Check them out on social media!Tik Tok: @maudlinInstagram: @maudlinListen on Spotify and YouTube!Have a paranormal experience to share? Reach out to us! Send us a message on social media, fill out our contact form, or shoot us an email (Hiddenintheshadowspodcast@gmail.com)Get ready for more spooky content coming soon! Follow us for updates. Hosted on Acast. See acast.com/privacy for more information.

In this spontaneous SPC episode, we dive deep into a wide-ranging conversation filled with mind-bending ideas and paranormal intrigue. These special episodes are where we unload everything we've been exploring lately—when there's too much to talk about for just one topic.We discuss Hemi-Sync meditations, the strange intersections of quantum mechanics and consciousness, and the ongoing evolution of Isaac's unique abilities, including his latest experiments with energy manipulation.From personal meditation breakthroughs to wild theories in quantum physics, this episode also features compelling stories about alien encounters, skinwalkers, and other unexplained phenomena that continue to challenge what we think we know.Whether you're here for the science, the supernatural, or the strange, Episode 8 offers a raw, unscripted look into the many realms we've been exploring.Topics Of EpisodeHere's a list of places and topics discussed in the episode:Hemi-sync meditation experiencesParanormal investigation at the parkEnergy manipulation and healing experimentsQuantum physics and multiverse theoriesSensory deprivation meditation techniquePast life regressionAlien encounter story Skin walker legend in AfghanistanSpiritual awakening experiencesBlack and white hole energy conceptParanormal conventions and dreamsSwamp and water-related visionsAlligator storiesUpcoming podcast interviewsPersonal paranormal abilities developmentLovin' the intro and outro music?"Swamp Witch”Our other intro Music: "Stacy Dahl" by MaudlinWant to hear more from Maudlin? Check them out on social media!Tik Tok: @maudlinInstagram: @maudlinListen on Spotify and YouTube!Have a paranormal experience to share? Reach out to us! Send us a message on social media, fill out our contact form, or shoot us an email (Hiddenintheshadowspodcast@gmail.com)Get ready for more spooky content coming soon! Follow us for updates. Hosted on Acast. See acast.com/privacy for more information.

Before we go any further, can we deep we're in June and the weather is looking like this? Good thing you all have the podcast to escape for however long each week

What Are Spiritual Songs? Biblical Examples & How to Write Your Own

Do you find yourself starting multiple projects or even businesses at the same time? Do you like and need variety in your day to day activities, do you experience ups and downs in your inspiration and ability to take action?In today's 20 min mini episode, I'm sharing more about what it means to have spontaneity vs rationality built into your nature.Understanding yourself is so key for architecting your own dream work as well as to loving and accepting yourself.If you enjoyed this episode, please share it with someone else, it really helps to support the podcast and allows more people to find it.And Happy June!Xo,Baiba

"The less you care, the harder you come."Your therapist won't tell you this, but caring too much is the ultimate cockblock to pleasure. And you, my sweet, overly invested friend, are drowning in a sea of giving-a-fuck when you could be floating in an ocean of delicious indifference.Welcome to this week's episode, where we're going to strip you of your precious concerns like a dominatrix peeling off your armor of good intentions.You think you need more love? More connection? More meaning?Wrong.What you need is the courage to stop giving a damn, and I'm here to hurt you in all the ways that'll set you free.Get ready for:- A master class in the art of strategic apathy- The dirty truth about why your caring addiction is cock-blocking your evolution- How psychedelics might divorce you from your neediness (and why that's hot)- The sexiest thing about power (hint: it doesn't care what you think about it)Listen as we explore why drama is the foreplay of existence, and how your resistance to pleasure is just fear wearing a consent-culture costume.This isn't self-help. This is self-harm in reverse – destroying the parts of you that keep sabotaging your liberation.If you're clutching your pearls of wisdom too tight to let new pleasure in, this episode will teach you the art of letting go like a zen master having a tantric breakthrough.WARNING: Side effects may include:- Spontaneous outbreaks of not giving a fuck- Increased pleasure tolerance- Decreased tolerance for your own bullshit- Sudden urges to prioritize your pleasure over others' comfort- The ability to say "no" without writing a thesis to justify itAvailable now wherever you get your permission to stop caring so damn much.The stakes are high, but your anxiety about them doesn't have to be.Come play in the space between caring too much and not caring at all. That's where the real pleasure lives.And remember: If you're worried about whether you should listen to this episode, that's exactly why you need to.Your enlightenment is optional. Your pleasure is mandatory.Got something to say to me? Slide into the DMs.Support the showIt's OUT! Sophistication Nation: Brief Interviews with Women I Pretend to Understand: https://emersondameron.hearnow.com/sophistication-nation

Spontaneous intracranial hypotension reflects a disruption of the normal continuous production, circulation, and reabsorption of CSF. Diagnosis requires the recognition of common and uncommon presentations, careful selection and scrutiny of brain and spine imaging, and, frequently, referral to specialist centers.  In this episode, Gordon Smith, MD, FAAN speaks with Jill C. Rau, MD, PhD, author of the article “Clinical Features and Diagnosis of Spontaneous Intracranial Hypotension” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Rau is an assistant professor of clinical neurology at the University of Arizona, School of Medicine-Phoenix in Phoenix, Arizona. Additional Resources Read the article: continuumjournal.com Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Full episode transcript available here Interview with Jill Rau, MD Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Smith: This is Dr Gordon Smith. Today I'm interviewing Dr Jill Rau about her article on clinical features and diagnosis of spontaneous intracranial hypotension, which she wrote with Dr Jeremy Cutsworth-Gregory from the Mayo Clinic. This article appears in the 2025 Continuum issue on disorders of CSF dynamics. I'm really excited to welcome you to the Continuum podcast. Maybe you can start by just telling our listeners a little bit about yourself? Dr Rau: Hi, thanks for having me. I'm really honored to be here, and I really enjoyed writing the paper with Dr Cutsforth-Gregory. I hope you guys enjoy it. I am the director of headache medicine at the Baba Bay Neuroscience Institute at Honor Health in Scottsdale, Arizona. I'm also currently the chair of the special interest group in CSF Dynamics at the American Headache Society, and I've had a special interest in this field since I first watched Dr Linda Gray speak at a conference where she talked about spinal CSF leaks and their different presentations. And they were so different than what I had been taught in residency. They're not just the post-LP headache. They have such a wide variety of presentations and how devastating they can be, and how much impact there is on someone's life when you find it and fix it. And I've been super interested in the field and involved in research since that time. And, yeah. Love it. Dr Smith: Well, thanks for sharing your story. And as I reflected on our conversation ahead of time and have been thinking about this issue… this is a cool topic, and every time I read one of these manuscripts and have the opportunity to speak with one of the authors, I learn a ton, because this was something that wasn't even on the radar when I trained back in the 1800's. So, really looking forward to the conversation. I wonder if you could really briefly just summarize or remind for everyone the normal physiology about CSF dynamics, you know, production, absorption, and so forth? Dr Rau: So, the CSF is the fluid that surrounds the brain and the spinal cord, and it's contained by the dura, which is like a canvas or a sac that covers that whole brain and spinal cord. And within the ventricles of the brain, the choroid plexus produce CSF. It's constantly producing and then being reabsorbed by the arachnoid granulations and pushed into the venous space, the cerebral sinuses, venous sinuses. And also some absorption and push into the lymphatics that we've just learned about in the past year. This is kind of new data coming out, so always learning more and more about CSF, but we know that it bathes the brain and the spinal cord, helps keep some buoyancy of the brain as well as pushing nutrients in and pulling out metabolic waste. And it sort of keeps the brain in the state of homeostasis that's happy. And so, when there's a disruption of that flow and the amount of fluid there, that disrupts that, that can cause lots of different symptoms and problems for people. Dr Smith: One of the many new things I learned is that even the name of this---spontaneous intracranial hypotension---is misleading. And I think this is clinically relevant, as we'll probably get to in a moment, but can you talk a little bit about this? Is this really like a pressure disorder or a volume disorder? Dr Rau: Yeah. It's almost certainly a volume disorder. We do see in some people that they have low pressure, and it's still part of the diagnostic criteria. But it's there because if you have a low pressure, if you measure an opening pressure and it's below six, if you're measuring it in the spine in the right place, then you have indication that there's low volume. But there's over 50% of people's opening pressure who have a spinal CSF leak, have all the symptoms and can be fixed. So, they have normal pressure in 50% of the people. So, it is an inaccurate term, hypotension, but it was originally discovered because of the thought that it was a low-pressure situation. Some of the findings would suggest low pressure, but ultimately, we are pretty sure it's a low-volume condition. Dr Smith: Another new thing that I learned that really blew me away is how bad this can be. I did a podcast with Mark Burish about cluster, and I was reminded many cluster patients are pushed to the point of suicidal ideation or committing suicide by the severity of pain. And this sounds like for many patients it's equally severe. Can you maybe paint a picture for our listeners why this is so clinically important? Dr Rau: A large number of people, even people who are known to have leaks because they've had them before or they've releaked, they have a lot of brain fog and cognitive impairment. They often have severe headaches when they're upright. So, orthostatic headache is probably the number one most common symptom, and those headaches are one of the worst headaches out there. When people stand up, their fluid is not supporting the brain and there's an intense amount of pain. And so, they spend a large portion of their lives horizontal. And there's associated symptoms with that, it's not just headache pain and brain fog. There's neck pain. There's often subsequent disorders that accompany this, like partial orthostatic tachycardia syndrome. We don't know if that's because of deconditioning or an actual sequela of the disease, but it's a frequent comorbidity. We have patients that have extreme dizziness with their symptoms, but many patients are limited to hours, if that, upright per day, combined, total. And so they live their lives, often, just in the dark, lots of photophobia, sensitive to the light, really unable to function. It's also very hard to find and so underrecognized that a lot of patients, especially if they don't have that really clinical symptom of orthostatic headache. So, it's often missed. So, they're just debilitated. You know, treatments don't work because it's not a migraine and it's not a typical headache. It's a mechanical issue as well as a metabolic issue and not found, not a lot helps it. Dr Smith: So, you know, I have always thought about this as really primarily an orthostatic symptom. I wonder if you can talk about the complexity of this; in particular, kind of how this evolves over time, because it's not quite that simple. And maybe in doing so, you can give our listeners some pearls on when they should be thinking about this disorder? Dr Rau: A large portion of people do have headache with spinal CSF leak, in particular, spontaneous intracranial hypertension- hypotension, excuse me. And that's something to be thought about, is that there are spontaneous conditions where people have either rupture of the dural sac, or an erosion of the dural sac, or a development of a connection between the dura and the venous system. And that is taking away or allowing CSF to escape. In these instances that patients have spontaneous, there may be a different presentation than if they have, like, a postdural puncture or a chronic traumatic or iatrogenic leak. And we're not sure of that yet, but we're looking into that. Still, the largest presentation is headache, and orthostatic headache is very dominant in the headache realm. But over time, patients' brains can compensate for that lack of CSF and start overproducing---or at least we think that's probably what's happening. And you may see a reduction in the orthostatic symptoms over time, and you may see an improvement in the radiographic findings. So, there are some interesting papers that have been published that look at these changes over time, and we do see that sometimes within that first three to four months; this is the most common time to see that change. Other patients may worsen. You may actually see someone going from looking sort of normal radiographically to developing more of a SIH-type of picture on the brain. And so it's not predictable which patients have gone from orthostatic to improvement or the other way around, both radiographically and clinically. So, it can be quite difficult to tell. So, for me, if I have a patient that comes to me and they're struggling with headache… if it's orthostatic, very clearly orthostatic: I lay down, I get considerably better or my headache completely goes away. And then when I stand up, it comes on relatively quickly, within an hour. And sometimes it's a worsening-throughout-the-day type of thing, it's lowest in the morning and it worsens throughout the day. These are the times that it's most obvious to think about CSF leak. Especially if that headache onset relatively suddenly, if it onset after a small trauma. Like I've had patients that say, you know, I was doing yoga and I did some twists and I felt kind of a pop. And then I've had this headache that is horrible when I'm upright but is better when I lay down ever since, you know, since that time. That's kind of a very classic presentation of spinal CSF leak or spontaneous intracranial hypotension. Maybe a less common presentation would be someone who comes to you, they've had a persistent headache for a couple years, they kind of remember it started in March of a couple years ago, but they don't know. Maybe it's, you know, it's a little better when they lay down. It may be a little worse when they're up moving around, but so is migraine, and it's a migrainous headache. But they've tried every migraine drug you can think of. Nothing is responding, nothing helps. I'm always looking at patients who are new daily, persistent headaches and patients who aren't responding to meds even if it's not new daily, but they have just barely any response. I will always go back and examine their brain imaging and get full spine to make sure I'm not missing. And you can never be 100% sure, but it's always good to consider those patients to the best of your ability, if that- have that in the back of your mind. Dr Smith: So obviously, goes without saying, this is something people need to have on their radar and think about. And then we'll talk more about diagnostic tools here in a second. But how common is this? If you're a headache doc, you see a lot of patients who have intractable headaches. And how often do you see this in your headache practice? Now you're- this is your thing, so probably a little more than others, but, you know, how common will someone who sees a lot of headache encounter these patients? Dr Rau: If you see a lot of headache, I mean, currently the thought is it's about 5 in 100,000. That was from a study before we were finding CSF venous fistulas. I think a lot of us think it's more common than that, but it's not super common. We don't have good estimates, but I would guess between 5 and 10 for 100,000 persons, not “persons who come to a tertiary headache clinic with intractable headaches”. So, it's hard to gauge how frequent it is, but I would say it's considerably more frequent than we currently think it is. There's still a group of people with orthostatic headaches that we can't find leaks on; that, once you treat other things that can cause or look for other things that can cause orthostatic headaches. So, there may be even still a pathophysiology out there that is still a leak type. Before 2014, we didn't even know about CSF venous fistulas. And now here we are; like, 50% of them are CSF venous fistulas. So, you know, we're still in a huge learning curve right now. Dr Smith: So, I definitely want to talk about the fistulas in a second. But before moving on, one of the things that I found really interesting is the wide spectrum of clinical phenotype. And we obviously don't have a lot of time to get into all of these different ones, but the one that I was hoping you might talk about---and there's a really great case, and you're on bunch of great case, a great case of this---is brain sagging dementia, not a term I've used before. Can you really briefly just tell our listeners about that, because that's a really interesting story and a great case in your article? Dr Rau: Yeah. So, brain sag dementia is a… almost like an extreme version of a spontaneous intracranial hypotension. Where there is clear brain sag in the imaging---so that's helpful---but the patients present kind of like a frontotemporal dementia. And when this was first started to being determined, you could turn the patient into Trendelenburg, and sometimes they would improve. There are some practitioners that have introduced fluid into the thecal sac and had temporary improvement. Patching has improvement, then they leak again, sometimes  not. But the clinical changes with this have been pretty tremendous to be able to identify that that's a real thing. And in some cases, out of Cedars Sinai, you know, who does a lot of the best research in this, they've had lots of cases where they can't find the leak, but there's clear brain sag that fits with our clinical picture of CSF leaks. So, we're on a learning curve. But yeah, this- they really present. They have disinhibition and cognitive impairment that is very similar to frontotemporal dementia. Dr Smith: Well, so let's talk about what causes this. You mentioned CSF venous fistulas. I mean, that was reported now just over a decade ago, it's pretty amazing. That accounts for about half of cases, if I understand correctly. What are the other causes? And then we'll talk more about therapy in a minute, but what causes this? Dr Rau: So, within the realm of spontaneous, you know, we say it's spontaneous. But the spontaneous cases we account for, they can be tears in the dura, which are usually sort of lateral tears in the dura. They can be little places that rubbed a hole, often on an osteophyte from the spine. They can come from these spinal diverticuli. So, I always describe it to my patients like those balls that have mesh and squishy, and you squeeze them in the- through the mesh, there's the extra little bubbling out. If you think of like the dura bubbling, out in some cases, through the framing of the spine, right where the spinal nerve roots come out, they should poke out like wires from the dura. But in many cases they poke out with this extra dura surrounding them, and we call that spinal diverticuli. And if you imagine like the weakening of where you squeeze that, you know, balloon through your fingers, in those locations, that's a very common place to find a CSF leak, and you can imagine that the integrity of the dura there may be less than it would be if it were not being expanded in that direction. And that's often the most common place we see these CSF venous fistulas. So, you can get minor traumas; like I said, it can be spontaneous, like someone just develops a leak one day. It can be rubbed off, and it can be a development of a connection between the dura and the venous system. There are also iatrogenic causes, but we don't consider them spontaneous. But when you're considering your patients for spontaneous cases, you should consider if they've ever had chronic---even long, long time ago---had any spinal implementation, procedures near the spine, spinal injections, LPs in the past, and especially women who've had epidurals in pregnancy. Dr Smith: All right, so we see a patient, positional severe headache, who meets the clinical criteria. Next step, MRI scan? Dr Rau: Yeah. So, the first thing is always to get the brain MRI with and without contrast. Most places will have a SIH or a spinal CSF leak protocol, but you should get contrast because one of the most pathognomonic findings on brain MRI is that smooth diffuse dural enhancement. And that's a really fantastic thing when you find it, because it's kind of a slam dunk. If you find it, then you will see other findings. It almost never exists alone. But if you see that, it's pretty much a spinal CSF leak. But you're also looking for subdural collections, any indication of brain sag. We do have these new algorithms that have come out in the past couple of years that are helpful. They're not exclusionary---you can have negative findings on the brain and still have spinal CSF leak---but the brain MRI is extremely helpful. If it's positive for the findings, it really does help you nudge you in the direction of further investigations and treatments. Dr Smith: And what about those further investigations and treatments, right? So, you see that there's findings consistent with low pressure, and I guess I should say low intracranial CSF volume. Be that as it may, what's the next step after that? Dr Rau: Depends on where you are and what you can do. I almost always will get a full spine MRI: so, C spine, T spine, and L spine separately. Not, you know, we don't want it all in one picture, because we want to get the full view. And you want to get that with at least T2 highly- heavily T2 weighted with fat saturation in at least the sagittal and axial planes. It's really helpful if you can get it in the coronal planes, but we have to have- often have good talks with your radiologist to get the coronal plane. I spoke about the spinal diverticuli earlier, and I want to clarify a little bit of something. The coronal image will show those really nicely. It's interesting, but 44% of people have those. So just having the spinal diverticuli does not indicate that you have a leak. But if you have a lot of those, there may be more likelihood of having leak than if you don't have any of those. So, I will get all of those and I will look at them myself, but I've been looking at them myself for a long time. But a lot of radiologists in community hospitals, especially not- nonneuroradiologists, but even neuroradiologists, this isn't something that's that everybody's been educated about, and we've been learning so much about it so rapidly in the past ten years. It's not easy to do and it's often missed. And if it's not protocoled properly, the fat saturation's not there, it's very hard to see… you can have a leak and not see it. Even the best people, like- it's not always something that's visible. And these CSF venous fistulas that we talked about are never visible on normal MRI imaging. Nonetheless, I will run those because if I can find a leak---and 90% of the ones that are found on MRI imaging are in the thoracic spine. So that's where I spend the most of my time looking. But if you find it, that's another thing to take to your team to say, hey, look, here it is, let's try and do this, or, let's try and do that, or, I've got more evidence. And there are other findings on the spine; not just the leak, but other findings, sometimes, you can see on spine that maybe help you push you towards, yes, this is probably a leak versus not. Dr Smith: So, your article has a lot of great examples and detail about kind of advanced imaging to, like, find the fistula and what not. I guess I'm thinking most of our listeners are probably practicing in a location where they don't have a team that really focuses on that. So, let's say we do the imaging of the spine and you don't find a clear cause. Is the next step to just do a blood patch? Do you send them to someone like you? What's the practical next step? Dr Rau: Yeah, if your- regardless of whether you find a leak or not, if your clinical acumen is such that you think this patient has a leak or I've treated them for everything else and it's not working and I have at least a high enough suspicion that I think the risk of getting a patch is lower than the benefit that if they got a patch and it worked, I do send my patients for non-directed blood patches, because it currently does take a long time to get them to a center that can do CT myelograms or any kind of advanced imaging to look for sort of a CSF venous fistula or to get treated outside of a nondirected patch. You know, sometimes nondirected patches are beneficial for patients, and there's some good papers out there that sort of explain the low risks of doing these if done properly versus the extreme benefit for patients when it works. And, I mean, I can't tell you how many people come in and tell me how their lives are changed because they finally got a blood patch. And sometimes it works. And it's life-changing for those people. You know, they go back to work. They can interact with their kids again. Before, they didn't know what was wrong, just had this headache that started. So it's worth doing if you have a strong clinical suspicion. Dr Smith: Yeah. I mean, that was great. And, you know, to go back to where we began, this is severe. It's something like 60% of patients with this problem have thought about suicide, right? And you take this patient and cure the problem. I feel really empowered having read the article and talked to you today. And so, I'm ready to go out and look for this. Thank you so much for a really engaging conversation. This has been terrific. Dr Rau: Thank you. I appreciate it. I enjoyed being here. Dr Smith: Again, today I've been interviewing Dr Jill Rau about her article on clinical features and diagnosis of spontaneous intracranial hypotension---which I guess I should say hypovolemia after having talked to you---which she wrote with Dr Jeremy Cutsworth-Gregory. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. Please be sure to check out Continuum Audio episodes from this really interesting issue and other interesting issues. And thank you, our listeners, again for listening to us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

This episode of Kiwi Birth Tales is proudly brought to you by Eve Wellness - supplements that become your body's new best friend. In this episode of Kiwi Birth Tales, I speak to Beatrice. Some of the topics we cover:Trying to conceive for 2 yearsFertility Therapist Spontaneous pregnancy Midwifery CareNIPTYour Birth Project and Antenatal ClassesWaters broke at home, labour didn't startMisoprostol inductionGood hospital midwives EpiduralInterventions after long pushing stageIssues with cord preventing baby coming downBirth CareLactation Consultant Nipple Shield Pelvic Floor PhysioYour Birth Project Online Hypnobirthing Coursehttps://www.fertilityassociates.co.nz/book-a-free-nurse-consultPlease seek support for any mental health concerns, some helpful links are below:Mental Health in PregnancyPerinatal Depression and Anxiety Aotearoa Plunket - Dads Mental HealthLittle Shadow - Private Counselling NZFind me @kiwibirthtales and @yourbirthproject Hosted on Acast. See acast.com/privacy for more information.

This week on our Vino Lingo segment William Simons, Wine Director & Director of Operations, Albi, Washington DC, defines the term “Spontaneous”.  Learn more by visiting albicd.com

Spontaneous adverse event reporting from healthcare professionals and patients is a cornerstone in pharmacovigilance systems. Unfortunately, it is a well-known issue that only a fraction of events is reported. To further complicate matters, poor quality reports present a significant challenge for pharmacovigilance assessors. In Uganda, several new routes have been introduced to facilitate reporting for patients and healthcare professionals, including email, WhatsApp and the Med Safety smartphone app. Henry Zakumumpa is a researcher at Makerere University in Kampala, Uganda. He has recently performed a qualitative study to learn more about drivers and obstacles for quality in adverse event reporting from patients and healthcare professionals in Uganda. He joins the Drug Safety Matters studio to help us get a more nuanced picture of challenges and opportunities around the issue.  Tune in to find out:Why are HIV patients in Uganda reluctant to report adverse events to their healthcare providers?What are the challenges with reporting via WhatsApp?How can regulators and PV centres foster better quality in incoming adverse event reports? Want to know more?Listen to Henry talk about the safety of HIV medications in this 2022 episode of Drug Safety Matters.Visit this CARTA (Consortium for Advanced Research Training in Africa) profile page to learn more about Henry's research.Improving the spontaneous reporting of suspected adverse drug reactions: An overview of systematic reviews (British Journal of Clinical Pharmacology, 2023)Improving adverse drug event reporting by healthcare professionals (Cochrane Database Systematic Review, 2024) Join the conversation on social mediaFollow us on Facebook, LinkedIn, X, or Bluesky and share your thoughts about the show with the hashtag #DrugSafetyMatters.Got a story to share?We're always looking for new content and interesting people to interview. If you have a great idea for a show, get in touch!About UMCRead more about Uppsala Monitoring Centre and how we work to advance medicines safety.

There are numerous accounts of people who suddenly find themselves unable to be seen - is this a real phenomenon, and perhaps even something that can be learned? We look at this topic, and look at the science that might (perhaps) show that it's quite possible. Help us keep the light on at TQM Towers and join us at Patreon.com/TQMPod - ad free shows a week ahead of everyone else, bonus eps, Discord...and shortly, exclusive merch.

 We are less than two weeks away from the start of Thom's Australia visit. We have a range of tour events scheduled, including free introductory talks and a learn to meditate course for those who are new to Vedic Meditation. If you've completed a qualified Vedic Meditation course, we invite you to join Tom for knowledge sessions, group meditations and a one-day retreat he has scheduled in Sydney.  Thom is also offering a five-day four-night retreat in Gerringong, south of Sydney, as well as private mentoring sessions throughout the month.  You can find out more about all of these offerings at thomknoles.com/sydney. Detachment is frequently sold as a necessary step for spiritual progress. We're taught that attachment is often the root of our suffering, so it stands to reason therefore, that detachment will bring about the opposite of suffering.But as Thom explains in this podcast episode, it's an understandable yet inaccurate conclusion that actually causes more suffering.Thom brings clarity to the subject, using the Vedic concept of vairagya, a state of being that allows us to fully enjoy the fruits of life, without the bondage of attachment.Episode Highlights[00:45] Maharishi Patanjali's Yoga Sutras[02:56] Siddhis - Developing Extraordinary Human Capabilities[05:36] A Spontaneous State of Non-attachment[09:48] A Witnessing Phenomenon[12:55] A Consequence of the Practice of Vedic Meditation[16:23] An Indication of Cosmic Consciousness[19:08] The Freedom of Spontaneous Non-attachmentUseful Linksinfo@thomknoles.com https://thomknoles.com/https://www.instagram.com/thethomknoleshttps://www.facebook.com/thethomknoleshttps://www.youtube.com/c/thomknoleshttps://thomknoles.com/ask-thom-anything/

Spontaneous short episodes recorded Off The Cuff from the heart and life of Matt Knoll.

Spontaneous short episodes recorded Off The Cuff from the heart and life of Matt Knoll.

What word starts with "F” and ends with "uck?” “Firetruck," of course!  Episode #156 hits the ground running with Lindsay's story about a guy in England who loved him some firetrucks. But scratching that itch to see a big red pumper (!) isn't always so easy. Then Jethro tells us about a guy who had a novel technique to score not only some quick cash, but two free pizzas!  What went wrong? Well, as Sean Connery so aptly put it in “The Hunt For Red October,” “Not everything in here reacts well to bullets.” Tune in to find out what happened – but remember to wash your hands first! Learn more about your ad choices. Visit megaphone.fm/adchoices

Stay sharp, sound confident, and speak with impact — even when you're put on the spot.Communicating clearly is challenging enough when there's time to prepare. But in most situations — whether in meetings, casual conversations, or high-stakes moments — we rarely have the luxury of scripting our words. We must think and speak in real time.Spontaneous communication is a daily challenge, yet few of us receive formal training in how to handle it with poise and confidence. So how can we stay composed and communicate effectively when put on the spot? Drawing on years of experience, our expert coaches — including a sports broadcaster, FBI negotiator, UN interpreter, game show host, NFL referee, and Sotheby's auctioneer — share their final pieces of advice to help answer that question.In this special episode of Think Fast, Talk Smart, the Spontaneous Speaking miniseries concludes with powerful tools, frameworks, and tips for staying calm, organizing your thoughts, and speaking with clarity under pressure. Matt Abrahams shares practical strategies and exercises designed to help you build lasting habits and sharpen your impromptu speaking skills.Whether you tend to freeze when caught off guard or simply want to express your ideas more effectively on the fly, this final installment will equip you to not only think fast — but speak smart.Episode Reference Links:Chris Voss - Former FBI Negotiator, Keynote SpeakerChris Voss's Book: Empathy and Understanding In Business  Annabelle Williams - Paralympic Champion, Sports BroadcasterGiampaolo Bianchi - United Nations InterpreterBrad Rogers - NFL Referee, ProfessorPhyllis Kao - Sotheby's AuctioneerPeter D Sagal - Game Show Host, AuthorConnect:Premium Signup >>>> Think Fast Talk Smart PremiumEmail Questions & Feedback >>> hello@fastersmarter.ioEpisode Transcripts >>> Think Fast Talk Smart WebsiteNewsletter Signup + English Language Learning >>> FasterSmarter.ioThink Fast Talk Smart >>> LinkedIn, Instagram, YouTubeMatt Abrahams >>> LinkedInChapters:(00:00) - Introduction (01:56) - The Power of Structure (05:48) - Expert Tip: Trust Yourself (06:09) - Expert Tip: Project Confidence & Provide Value (07:48) - Expert Tip: Ask for What You Need & Visualization (10:15) - Expert Tip: Review & Reflect (12:15) - Expert Tip: Use an Encouraging Tone (12:36) - Expert Tip: Turn Observation into Storytelling (14:29) - Conclusion    ********This episode is sponsored by Grammarly. Let Grammarly take the busywork off your plate so you can focus on high-impact work. Download Grammarly for free today Become a Faster Smarter Supporter by joining TFTS Premium.   

Send us a textIn this episode, Ebony shares the story of her first birth — a journey that began with a planned homebirth and unfolded in unexpected ways. After a long labour and signs of possible malposition, her care team discovered meconium in the waters and an elevated heart rate in her baby. At that point, Ebony made the decision to transfer to hospital via ambulance.At the hospital, doctors attempted a manual rotation and three vacuum-assisted birth attempts before her baby was born by caesarean. Ebony speaks openly about the intensity of the experience, the breastfeeding challenges she faced in the early weeks, and how she worked through the emotional impact of the transfer with support from a psychologist.Links:Mothers & Babies Report - Instrumental BirthVacuum Extraction InfoForceps Delivery InfoQLD Clinical Guidelines - Instrumental Vaginal BirthSupport the show@homebirthstoriesaustralia Support the show by buying us a coffee! Please be advised that this podcast may contain explicit language. Listener discretion is advised.The information, statistics, and research presented in this podcast are for informational purposes only and are not intended to constitute or replace medical or midwifery advice. All information discussed can be found online and is provided in the links in the show notes. It is always recommended to conduct your own research and make informed decisions. We advise you to discuss any topics or concerns with your healthcare provider. While we strive to incorporate the most up-to-date research in our episodes, we do not warrant or guarantee the accuracy of the information discussed on the show.

Adam Friedman, MD, FAAD interviewed by Sabrina Shearer, MD, FAAD

In my explanation of my current stats project (Blame Banks), I take you behind the scenes of my madness and we spend WAY too much time talking about D-Lo Brown, whom one Cagematch commenter has called "The Greatest Mid-Carder of all time".

Welcome back to Spontaneous! This is the last episode of the season, but don't worry—Brittney and Keilani will be returning with new episodes soon! It's just time for a revamp as the girls will be getting a new roommate and co-host!Brittney and Keilani feel bittersweet about this episode. They have cherished every moment of connecting with all of you on Spontaneous, and they are also excited about the big changes ahead that they hope you will love. Please continue this journey with them, as they will return for new episodes under a new name, and they can't wait to share that announcement with you! In today's episode, they reflect on some of their favorite memories from Spontaneous and express their deepest gratitude for all of you who listen.

Dr. Jessica Ailani and Dr. Kathleen Digre discuss the evolution of spontaneous intracranial hypotension (SIH) diagnosis and treatment over the past decade.

Hi guys,You probably already know this, but in addition to publishing a daily letter on Substack—and posting all sorts of other content all over the place too—I also record a weekly video podcast.Today I got into a bit of on overthinking spiral about whether to keep doing both the letters and the podcast, since there tends to be a lot of overlap between them.At some point today, I also changed podcast hosting platforms—from Spotify to Substack—as part of my Walden Year energy of simplifying & consolidating platforms. It just sorta happened.After the podcast fully switched over to Substack (which still distributes to Spotify, Apple Podcasts, & even YouTube, by the way) I suddenly became a bit worried that I was making my Substack too cluttered and that I'd annoy people with two emails coming through on Fridays.However… I did post this one time on Instagram…So… erm…I guess here goes!Something I could do if enough people reply to this email and tell me “I'm annoyed” is I could uncheck the “email” button when I post podcast episodes to Substack, that way they will just show up on the podcast platforms like normal without any emails coming through.But also…As Arthur Russel once said…It's my worldIt's my songDidn't ask you to come along!So you can always just unfollow me if you're annoyed.No but seriously I love you guys dearly.Dearly.Talk soon, and have a beautiful weekend.Love,Georgie P This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit georgepoulos.substack.com

Earth Day...audiohttp://feeds.feedburner.com/RadioTroubleArchives

spontaneous selections...audio / playlisthttp://feeds.feedburner.com/RadioTroubleArchives

Temple Ball...audio / playlisthttp://feeds.feedburner.com/RadioTroubleArchives

really spontaneous selections...audio / playlisthttp://feeds.feedburner.com/RadioTroubleArchives

Experimental/Electronic with pxe, dAs & univac...audio http://feeds.feedburner.com/RadioTroubleArchives

Dr. Jessica Ailani talks with Dr. Kathleen Digre about the evolution of spontaneous intracranial hypotension (SIH) diagnosis and treatment over the past decade. Disclosures can be found at Neurology.org. 

Once too many...audio / playlisthttp://feeds.feedburner.com/RadioTroubleArchives

Welcome back to a new episode of Spontaneous! This week, Brittney and Keilani are excited to dive into the entire process of moving to and within New York City. They will discuss their journey of getting their first apartment three years ago, how they found their new apartment, and the thoughts and feelings associated with moving in the city. Additionally, they will highlight some of the significant differences between the two apartments and share what they love and dislike about each one. The girls will also provide an update on how things have been and will share what's currently on their watchlist, including some great shows! You don't want to miss it! New Episodes Every Saturday! Instagram @spontaneouspod @brittneyscardina @keilanipeleti TikTok: @spontaneouspod8Email: spontaneouspod@gmail.com

Spontaneous short episodes recorded Off The Cuff from the heart and life of Matt Knoll.

Spontaneous twin pregnancies occur in about 1 out of every 250 pregnancies. A real world clinical question has to do with dating a spontaneous twin gestation: Do we use the smaller crown rump length or the larger for dating in the 1st trimester? Do we use the smaller or larger measurement of biometry in the 2nd trimester? We had this discussion today in our prenatal clinic, and in true form and fashion, I turned it into an episode! PLUS, there is practice guidance from Jan 2025 (ISUOG) to settle the debate. Listen in for details.

Join Michaela in this live workshop recording as she discusses the best way to learn tantra, what it means to be a well matched couple, the art and practice of ecstatic intimacy, how to live a joyous life, and the jar exercise. 00:00 - Well matched couples 02:01 - The best way to learn tantra 03:24 - The preliminaries and essence of tantric intimacy 07:00 - Spontaneous ecstasy and practices of bliss 08:48 - Central channel and NLMM 10:19 - Code words and quick communication 12:39 - How to live a joyous life 14:48 - The jar exercise Buy Michaela's Relationship Course: https://www.michaelaboehm.com/workshops/instant-access-the-untamed-heart-the-relationship-course/ Attend the Relationship Bootcamps in: - London, 28-29th June - https://www.michaelaboehm.com/workshops/june-28-29-the-relationship-bootcamp-weekend-intensive-london/ - Ojai, California, 19-21th September - https://www.michaelaboehm.com/workshops/september-19-21-the-relationship-bootcamp-a-3-day-intensive/ For retreats, workshops, teacher trainings and courses: https://www.michaelaboehm.com To order Michaela's book "The Wild Woman's Way" : https://amzn.to/2BQ5WpY Music ‘Deva Dasi' by Steve James at https://www.guruviking.com

In this episode, I am joined by Lopon Yudron Wangmo, American teacher of Tibetan Buddhism and author of several books including her recent “Clearing the Way to Awakening”. Lopon Yudron Wangmo offers an analysis of the shortcomings of today's Buddhist literature, details the writing process for “Clearing the Way to Awakening”, and reveals the stylistic and language choices she made to better reach the average reader. Lopon Yudron Wangmo describes the power of the ngondro preliminary practices of Tibetan Buddhism and explains the techniques of mantra recitation, prostrations, mandala offerings, bodhicitta generation, tummo, śamata, and more. Lopon Yudron Wangmo extols the benefits of turning away from worldly life and towards religion, reports the fruits of her own practice such as profound peace and joy, warns about the danger of following a guru without first testing him, and advises on how to work with the supernatural dimension of Buddhism. … Video version: https://www.guruviking.com/podcast/ep303-clearing-the-way-to-awakening-lopon-yudron-wangmo Also available on Youtube, iTunes, & Spotify – search ‘Guru Viking Podcast'. … Topics include: 00:00 - Intro 01:04 - Clearing the Way to Awakening 01:52 - The problem with today's Buddhist literature 03:20 - Sublime topics 04:22 - Style considerations for today's reading level 06:03 - Learning to write more simply for the average reader 07:18 - Patrul Rinpoche and avoiding imitation 08:30 - What is awakening? 09:09 - Local context in Buddhist cultures 10:34 - Buddha's description of his awakening 12:37 - Working with the supernatural dimension of Buddhism 14:25 - The ālaya vijñāna and the unconscious mind 17:34 - Buddha nature vs being driven and unconscious 18:57 - Gradualist vs subitist awakening 20:22 - The role of ngondro and the power of visualisation 22:51 - The power of recitation 24:05 - The power of prostrations 26:17 - The power of maṇḍala offerings 28:13 - Why esoteric practices are not appropriate for most people 30:00 - The secrets to completing your ngondro 32:27 - The importance of motivation 33:15 - The anti-climax of realising the nature of mind 35:33 - Tummo and śamata 36:50 - Origin of the ngondro system + Theravada critique 39:17 - Taking refuge 40:30 - Generating bodhicitta and practicing the four immeasurables 41:12 - Vajrasattva and purification practice 42:21 - Merit making and guru yoga 44:06 - If you don't like it, don't practice it 45:04 - Yudron asks for Steve's opinion 46:58 - Choose your Buddhism 48:23 - Disillusionment with saṃsāra and choosing Buddhism later in life 50:03 - The power of choice and acquired ADHD 51:43 - Get on it 52:38 - The power of disillusionment and renunciation 55:07 - The peace and joy of turning away from the world 57:41 - The suffering of loneliness and the fruits of practice 01:00:09 - The mechanism of spiritual contentment 01:02:04 - Yudron on the importance of disclosing attainments 01:03:28 - Spiritual saints 01:04:13 - Political lamas and checking out gurus 01:05:32 - Personal relationship with the guru 01:07:13 - We're all devoted to something 01:09:09 - Pitfalls of ngondro: anxiety, OCD, depression, and PTSD 01:14:06 - Yudron's struggles with depression and anxiety 01:19:34 - Boomer Buddhists 01:20:04 - Preliminary or foundational? 01:22:06 - Jetsunma Tenzin Palmo's advice about retreat 01:23:38 - Congratulated by Vajrasattva and the ontology of deities 01:26:45 - Spontaneous feelings of love To find out more about Lopon Yudron Wangmo, visit: - https://www.yudronwangmo.com/ For more interviews, videos, and more visit: - https://www.guruviking.com Music ‘Deva Dasi' by Steve James

The lads discuss shower enclosures, organised craic and influencers getting scammed out of it.

This three-part miniseries is all about keeping your cool when speaking on the spot.Communicating effectively can be challenging enough, even with plenty of time to prepare what we want to say. But for most of our communication, there's no time to plan, practice, or perfect — we have to respond in the moment.Spontaneous communication is a part of our everyday lives, but few of us have been trained to handle these impromptu situations with confidence. What does it take to flow, not freeze, when put on the spot? This special three-part series turns to experts for guidance, from a sports commentator, FBI hostage negotiator, and UN translator to a game show host, NFL referee and Sotheby's auctioneer.Part 1: Preparation and MindsetDiscover how to prepare for the unpredictable, manage anxiety, and find the right headspace for success.Part 2: Mastering the MomentLearn to stay present, read the room, and use techniques like mirroring and pacing to connect with your audience.Part 3: When Things Go WrongFind out how to recover from inevitable mishaps and keep moving forward with confidence, turning mistakes into gold.In addition to insight-packed discussions, this Think Fast, Talk Smart miniseries offers practical exercises and homework assignments to help you implement what you've learned. Whether you draw blanks when put on the spot or simply want to articulate your thoughts more clearly in the moment, these episodes will transform how you think — and speak — on your feet.Episode Reference Links:Chris Voss - Former FBI Negotiator, Keynote SpeakerChris Voss's Book: Empathy and Understanding In Business  Annabelle Williams - Paralympic Champion, Sports BroadcasterGiampaolo Bianchi - United Nations InterpreterBrad Rogers - NFL Referee, ProfessorPhyllis Kao - Sotheby's AuctioneerPeter D Sagal - Game Show Host, AuthorConnect:Premium Signup >>>> Think Fast Talk Smart PremiumEmail Questions & Feedback >>> hello@fastersmarter.ioEpisode Transcripts >>> Think Fast Talk Smart WebsiteNewsletter Signup + English Language Learning >>> FasterSmarter.ioThink Fast Talk Smart >>> LinkedIn, Instagram, YouTubeMatt Abrahams >>> LinkedInChapters:(00:00) - Introduction (02:42) - Focus on What's Next, Not What Went Wrong (04:40) - Failure with Confidence (06:45) - Flexibility Over a Fixed Plan (08:28) - Staying Cool in Public Slip-Ups (10:36) - Using Laughter to Reset (13:05) - Gracefully Correcting Yourself (14:42) - Staying Calm Under Pressure (19:40) - Listener Exercises on Reflecting to Improve (21:56) - Conclusion   *****Stay up to date on the next great discovery at Stanford by signing up for the Stanford ReportBecome a Faster Smarter Supporter by joining TFTS Premium.      

This three-part miniseries is all about keeping your cool when speaking on the spot.Communicating effectively can be challenging enough, even with plenty of time to prepare what we want to say. But for most of our communication, there's no time to plan, practice, or perfect — we have to respond in the moment.Spontaneous communication is a part of our everyday lives, but few of us have been trained to handle these impromptu situations with confidence. What does it take to flow, not freeze, when put on the spot? This special three-part series turns to experts for guidance, from a sports commentator, FBI hostage negotiator, and UN translator to a game show host, NFL referee and Sotheby's auctioneer.Part 1: Preparation and MindsetDiscover how to prepare for the unpredictable, manage anxiety, and find the right headspace for success.Part 2: Mastering the MomentLearn to stay present, read the room, and use techniques like mirroring and pacing to connect with your audience.Part 3: When Things Go WrongFind out how to recover from inevitable mishaps and keep moving forward with confidence, turning mistakes into gold.In addition to insight-packed discussions, this Think Fast, Talk Smart miniseries offers practical exercises and homework assignments to help you implement what you've learned. Whether you draw blanks when put on the spot or simply want to articulate your thoughts more clearly in the moment, these episodes will transform how you think — and speak — on your feet.Episode Reference Links:Chris Voss - Former FBI Negotiator, Keynote SpeakerChris Voss's Book: Empathy and Understanding In Business  Annabelle Williams - Paralympic Champion, Sports BroadcasterGiampaolo Bianchi - United Nations InterpreterBrad Rogers - NFL Referee, ProfessorPhyllis Kao - Sotheby's AuctioneerPeter D Sagal - Game Show Host, AuthorConnect:Premium Signup >>>> Think Fast Talk Smart PremiumEmail Questions & Feedback >>> hello@fastersmarter.ioEpisode Transcripts >>> Think Fast Talk Smart WebsiteNewsletter Signup + English Language Learning >>> FasterSmarter.ioThink Fast Talk Smart >>> LinkedIn, Instagram, YouTubeMatt Abrahams >>> LinkedInChapters:(00:00) - Introduction (02:25) - Letting Go of the Script (05:37) - Visual Listening (06:56) - Nonverbal Communication (09:45) - Tools of Connection (13:06) - Pacing for Pressure (14:06) - The Power of Pausing (16:40) - How to Make a Great Introduction (18:30) - Being Gracious in Conversation (20:54) - Listener Exercises on Active Listening (23:48) - Conclusion  *****Stay Informed on Stanford's world changing research by signing up for the Stanford ReportBecome a Faster Smarter Supporter by joining TFTS Premium.     

Michael hosts a compelling conversation centered around immigration, undocumented workers, and the everyday realities of hiring day laborers—sparked by a memorable and candid call from "Tom in Texas." This came after a conversation with Philip Bump at the Washington Post about how the story of Kilmar Abrego García - the Maryland man mistakenly deported to El Salvador after being arrested trying to get day labor work outside a Home Depot - tells us far more than the narrative on immigration and deportation we are hearing from the Trump White House. Original air date 17 April 2025.

Matt is joined by Darold Gleason to talk about their recent trip to Columbia County, Georgia and Clarks Hill Lake (along with the Masters).  In the second half of the show, the always positive Charlie Hartley jumps on to talk about the Open in Mississippi.  

His far-reaching career acting, writing and producing on television and film spans voicing a sloth in the movie Ice Age to hosting a PBS series on the untold history of Latinos in the US. He's fast talking, funny, outspoken and possesses a rare quality in his acting – on display in his new movie Bob Trevino Likes It.

This three-part miniseries is all about keeping your cool when speaking on the spot.Communicating effectively can be challenging enough, even with plenty of time to prepare what we want to say. But for most of our communication, there's no time to plan, practice, or perfect — we have to respond in the moment.Spontaneous communication is a part of our everyday lives, but few of us have been trained to handle these impromptu situations with confidence. What does it take to flow, not freeze, when put on the spot? This special three-part series turns to experts for guidance, from a sports commentator, FBI hostage negotiator, and UN translator to a game show host, NFL referee and Sotheby's auctioneer.Part 1: Preparation and MindsetDiscover how to prepare for the unpredictable, manage anxiety, and find the right headspace for success.Part 2: Mastering the MomentLearn to stay present, read the room, and use techniques like mirroring and pacing to connect with your audience.Part 3: When Things Go WrongFind out how to recover from inevitable mishaps and keep moving forward with confidence, turning mistakes into gold.In addition to insight-packed discussions, this Think Fast, Talk Smart miniseries offers practical exercises and homework assignments to help you implement what you've learned. Whether you draw blanks when put on the spot or simply want to articulate your thoughts more clearly in the moment, these episodes will transform how you think — and speak — on your feet.Episode Reference Links:Chris Voss - Former FBI Negotiator, Keynote SpeakerChris Voss's Book: Empathy and Understanding In Business  Annabelle Williams - Paralympic Champion, Sports BroadcasterGiampaolo Bianchi - United Nations InterpreterBrad Rogers - NFL Referee, ProfessorPhyllis Kao - Sotheby's AuctioneerPeter D Sagal - Game Show Host, AuthorConnect:Premium Signup >>>> Think Fast Talk Smart PremiumEmail Questions & Feedback >>> hello@fastersmarter.ioEpisode Transcripts >>> Think Fast Talk Smart WebsiteNewsletter Signup + English Language Learning >>> FasterSmarter.ioThink Fast Talk Smart >>> LinkedIn, Instagram, YouTubeMatt Abrahams >>> LinkedInChapters:(00:00) - Introduction (04:12) - Pressure and Preparation (06:03) - Cognitive Load and Focus (08:47) - Speaking with Clarity (10:25) - Building Instinct Through Practice (12:29) - Overthinking vs. Acting Fast (14:09) - Staying Present Under Pressure (14:49) - Make It About the Audience (15:50) - Handling Public Scrutiny (17:54) - Physical Rituals to Manage Nerves (19:27) - Grounding Techniques Before Speaking (22:01) - Listener Exercises for Better Speaking (25:18) - Conclusion  *****Stay Informed on Stanford's world changing research by signing up for the Stanford ReportBecome a Faster Smarter Supporter by joining TFTS Premium.     

On this episode of the 4:13, we're diving into the joy-filled adventure of chasing whimsy—a path to discovering the uplifting, inspiring, and unexpected possibilities that await you every single day. With his signature storytelling and winsome take on life, bestselling author Bob Goff reveals how whimsy isn't just about enthusiasm—it's a deeply purposeful way of living. It's where intentionality meets curiosity, where interruptions become invitations, and where delight flips the script on your bad days. You'll learn how to embrace spontaneity with anticipation and wonder, use humor as a tool to broaden your perspective, and see life's mundane moments as onramps to meaningful experiences.  So, if you're ready to wake up to the marvelous adventure that is your life, hit play, and let's chase some whimsy together! SHOW NOTES: 413Podcast.com/345 Enter to win the GIVEAWAY and read the episode TRANSCRIPT in the show notes. Get my weekly email, Java with Jennifer, to be notified when a new podcast episode releases. Subscribe HERE.

Want more impactful spontaneous worship moments? Bethel Music's Emmy Rose shares the exact tips that help her flow with the Spirit—and the surprising ways those same tips can totally backfire.  Whether you're just learning how to flow or you've been chasing those spontaneous moments for years, this episode will challenge, equip, and stretch you.  Hit play… but consider this your warning—what helps you might also hurt you if you're not paying attention.  Worship Online is your new secret weapon for preparing each week. With detailed song tutorials and resources, you and your team will save hours every single week, and remove the stress from preparing for a set. Try a free trial at WorshipOnline.com and see the transformation!   Mentioned in the Episode  Tend by Emmy Rose  ---  If you like what you hear, please leave us a review! Also, shoot us an e-mail at podcast@worshiponline.com. We want to know how we can better serve you and your church through this podcast.  Don't forget to sign up for your FREE 2-week subscription to Worship Online at WorshipOnline.com!  The Worship Online Podcast is produced by Worship Online in Nashville, TN.