Podcasts about Summarize

898 The Lord Founded the Earth by Wisdom, A Guided Christian Meditation on Proverbs 3:19-23 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable doing so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation Proverbs 3:19-23 NRSVA NET By wisdom the Lord laid the foundation of the earth; he established the heavens by understanding. 20 By his knowledge the primordial sea was broken open, so that the clouds drip down dew. 21 My child, do not let them escape from your sight; safeguard sound wisdom and discretion. 22 So they will become life for your soul, and grace around your neck. 23 Then you will walk on your way with security, and you will not stumble. NASB 19 The Lord founded the earth by wisdom, He established the heavens by understanding. 20 By His knowledge the ocean depths were burst open, And the clouds drip with dew. 21 My son, see that they do not escape from your sight; Comply with sound wisdom and discretion, 22 And they will be life to your soul And adornment to your neck. 23 Then you will walk in your way securely, And your foot will not stumble. Reflection on Scripture: What does God know? Reflect on the different things that God knows. I think many times when we think about God's wisdom we consider moral things. Perhaps we think about how God knows the future. It is beyond that. God… knows… everything… God knows philosophy, all of it He knows physics, He knows history, and metaphysics He knows Psychology, he knows genetics, he knows all possible technologies including ones we will never discover He knows drug pharmacology. He knows how to force atoms together. He has an understanding of the foundation of the universe. He definitely knows what you need and what you want. He knows how to help you overcome every weakness and sin. God has knowledge of everything. Not just what humans have figured out but beyond that.  God knows everything. Not just that but he is all wise. Wisdom and knowledge are not the same thing. Knowledge is having a collection of facts; wisdom is knowing how to apply knowledge God has both He knows how to set galactic foundations. The sea, representing chaos, he knows how to quell. He knows how to form clouds and cause them to create dew and rain If we are able to learn from God and then follow God's spirit of wisdom, then we will have the knowledge and wisdom needed to accomplish what we need to in life. You will not stumble Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

As the Summer 2026 season ends, we review a title from...Summer 2026, as Gerald reviews The Ghost in the Shell, which for the first time directly adapts the original manga by Masamune Shirow. Visit www.animeworldorder.com for full show notes and supplemental links.

Week two of the 2026 NFL season was manifestly momentous and historically significant, and we convey that central observation without equivocation. I was joined by Ed Kleese as we cataloged an array of notable milestones, among them Devin Lloyd's exceedingly rare single-game compilation of a sack, multiple interceptions, and a touchdown; Patrick Mahomes' ascension to an 8–0 mark in regular-season overtime contests, thereby establishing a new NFL benchmark; and the fact that no new Scorigami was recorded this week, with 41–31 (Buffalo over Detroit) registering as the rarest final score.The origin of the "Scoregasm" comes to life here, in a story from Ed you don't want to miss!We examined franchise-specific anomalies and streaks, including the Panthers' defensive resurgence, the Steelers' prolonged difficulties in Foxborough since the Brady era, Dak Prescott's record-tying dominance in AT&T Stadium against NFC East opponents, and the Browns' emerging rookie Denzel Boston entering the record books with successive long touchdown receptions. We further observed that the Packers–Jets 20–17 result remains the most prevalent final score in league annals, now occurring for the 303rd time, and that our week-two Scorigami ME index registered a 73.18. I invite the audience to regard these developments as substantive contributions to the evolving ledger of football history, and we will continue to preserve and expound upon such records in subsequent discussions.Don't forget to check out and subscribe to the Pigskin Dispatch YouTube channel for additional content and the regular Football History Minute Shorts.Miss our football by the day of the year podcasts, well, don't, because they can still be found at the Pigskin Dispatch website. Do you want more football history? Test your Gridiron Knowledge, we feed you Daily with our new FREE activity, The Pigskin Trivia Drive.Grab a copy of our latest book, "Marooned," on the 1925 Pottsville Maroons NFL franchise saga.*OR* Grab a copy of our book on Western Pennsylvania football history, "World's Greatest Gridiron Team" on the 1903 Franklin All-StarsDrop us a line at PigskinDispatch@gmail .com and check out and subscribe to the Pigskin Dispatch YouTube channel.Contact us directly at PigskinDispatch@Gmail.comMiss our football by the day of the year podcasts, well, don't because they can still be found at the Pigskin Dispatch website.

896 Happy Are Those Who Find Wisdom, A Guided Christian Meditation on Proverbs 3:13-18 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable doing so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation Proverbs 3:9-12 NRSVA 13 Happy are those who find wisdom,     and those who get understanding, 14 for her income is better than silver,     and her revenue better than gold. 15 She is more precious than jewels,     and nothing you desire can compare with her. 16 Long life is in her right hand;     in her left hand are riches and honour. 17 Her ways are ways of pleasantness,     and all her paths are peace. 18 She is a tree of life to those who lay hold of her;     those who hold her fast are called happy. KJV 13 Happy is the man that findeth wisdom, and the man that getteth understanding. 14 For the merchandise of it is better than the merchandise of silver, and the gain thereof than fine gold. 15 She is more precious than rubies: and all the things thou canst desire are not to be compared unto her. 16 Length of days is in her right hand; and in her left hand riches and honour. 17 Her ways are ways of pleasantness, and all her paths are peace. 18 She is a tree of life to them that lay hold upon her: and happy is every one that retaineth her. and refreshment to your inner self. Reflection on Scripture: What is true wisdom? As someone who has studied a lot of ideas of humans in the form of advanced mathematics and physics I find the question of what wisdom is, to be fascinating. As I've learned about philosophers I find some ideas interesting yet it does not compare to the value of the wisdom of the Lord? I was talking with a young man who was really struggling because he felt he wasn't measuring up to what he wanted his life to become. I spent a great deal of time challenging his notion. He was looking for what would make his life feel like it was good enough. The reality is that there is no eternal philosophy of man. When we try to live for ourselves in our own will be eternally unsatisfying  As an example. Solomon is pondering all the wisdom he had acquired, and even more curious is that his wisdom was a gift from God. And yet when he reflected on the truth and depth of his wisdom he realized that the only thing that mattered was the wisdom of the Lord. When we look at his life we discover a perfect example of this problem. God gave his wisdom, his wisdom became world renowned and he gained great wealth as a result. Yet as his influence grew, he allowed for his attention to be taken away from the Lord and even yield toward false gods. And then the end of his life was tipified with disappointment and failure. The only success he found in life was by learning the wisdom of God.  What would God's wisdom move you toward in your life? What challenge or struggle have you been working through in life? How would God's wisdom change your perspective on it? What of human wisdom is not working for you and how can you incorporate God's wisdom in its place. Ponder on that.  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

You stayed late again, the service is still short-staffed, and when you finally say something, the answer is: you just need to be more efficient. More resilient. That's the go-to explanation for almost everything hard about residency — but what if the problem isn't your resilience at all? In the finale of Beyond the Match, Mckenzie Roebuck, Carl Engelke, Michael Brinton, and Omer Hassan of CoSEF look downstream at what happens after residents match: working conditions, culture and mental health, the practical barriers that make transferring so difficult, why residents may not trust existing reporting systems, and what real accountability and resident voice would require.Hosts:  Dr. Mckenzie Roebuck, CoSEF BTK Lead, Inova Fairfax Medical Campus, mckenzie.rowe@inova.org Dr. Carl Engelke, The Ohio State University, Carl.Engelke@osumc.edu  Dr. Michael Brinton, Medical College of Wisconsin, mbrinton@mcw.edu   Dr. Omer Hassan, University of Calgary/Alberta Children's Hospital, omerh91@gmail.com CoSEF: X @surgedfellows, cosef.org  Learning objectives: Summarize the real problems the congressional report identifies in working conditions, mistreatment reporting, and resident mental health Distinguish necessary difficulty in residency training from preventable system dysfunction, and describe its relationship to resident well-being and reporting Explain the practical barriers to resident mobility, including position availability, training requirements, funding, visa status, professional risk, and stigma Describe local and national accountability mechanisms — including program reporting, GMECs, ACGME pathways, and unions — and the limitations of each Identify strategies to strengthen resident voice, psychological safety, anti-retaliation protections, and institutional accountability rather than relying on individual resilience alone.  References: House Committee on the Judiciary. Medical Mis-Match: How a Residency Hiring Monopoly Harms Patients, Doctors, and the American Public. Published online March 27, 2026. Gianakos AL, Freischlag JA, Mercurio AM, et al. Bullying, Discrimination, Harassment, Sexual Harassment, and the Fear of Retaliation During Surgical Residency Training: A Systematic Review. World J Surg. 2022;46(7):1587-1599. doi:10.1007/s00268-021-06432-6PubMed Link: https://pubmed.ncbi.nlm.nih.gov/35006329/ Mata DA, Ramos MA, Bansal N, et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. 2015;314(22):2373-2383. doi:10.1001/jama.2015.15845PubMed Link: https://pubmed.ncbi.nlm.nih.gov/26647259/ Malone TL, Zhao Z, Liu TY, Song PXK, Sen S, Scott LJ. Prediction of Suicidal Ideation Risk in a Prospective Cohort Study of Medical Interns. PLoS One. 2021;16(12):e0260620. doi:10.1371/journal.pone.0260620PubMed Link: https://pubmed.ncbi.nlm.nih.gov/34855821/ Drolet BC, Schwede M, Bishop KD, Fischer SA. Compliance and Falsification of Duty Hours: Reports From Residents and Program Directors. J Grad Med Educ. 2013;5(3):368-373. doi:10.4300/JGME-D-12-00375.1PubMed Link: https://pubmed.ncbi.nlm.nih.gov/24404298/ National Resident Matching Program. The Match Agreement. Accessed August 2026. https://www.nrmp.org/intro-to-the-match/the-match-agreement/. Intealth (ECFMG). J-1 Physicians Training in the US (infographic). Accessed August 2026. https://www.intealth.org/pdfs/J-1_US_Infographic.pdf. (Note: Institutional PDF; no PubMed entry available). Foote DC, Rosenblatt AE, Amortegui D, et al. Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff. JAMA Netw Open. 2024;7(7):e2421676. doi:10.1001/jamanetworkopen.2024.21676PubMed Link: https://pubmed.ncbi.nlm.nih.gov/39018072/ Accreditation Council for Graduate Medical Education. Report an Issue. https://www.acgme.org/residents-and-fellows/report-an-issue/?utm_source. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewOBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-reviewSurgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-reviewEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Today is day 260 and we are studying The Ten Commandments. 260. How did Jesus summarize God's Law? Jesus summarized God's Law by saying: “You shall love the Lord your God with all your heart and with all your soul and with all your mind. This is the great and first commandment. And a second is like it: You shall love your neighbor as yourself. On these two commandments depend all the Law and the Prophets.” (Matthew 22:37–40; see also Deuteronomy 6:1–9; Leviticus 19:9–18; Psalm 31:23–24; John 15:7–17; 1 John 4:16–5:3) We will conclude today by praying the Collect for the Fifth Sunday in Lent found on page 606 of the Book of Common Prayer (2019). If you would like to buy or download To Be a Christian, head to anglicanchurch.net/catechism. Produced by Holy Trinity Anglican Church in Madison, MS. Original music from Matthew Clark. Daily collects and Psalms are taken from Book of Common Prayer (2019), created by the Anglican Church in North America and published by the Anglican Liturgical Press. Used by permission. All rights reserved. Scripture quotations are from The ESV® Bible (The Holy Bible, English Standard Version®), copyright © 2001 by Crossway, a publishing ministry of Good News Publishers. Used by permission. All rights reserved. Catechism readings are taken from To Be a Christian - An Anglican Catechism Approved Edition, copyright © 2020 by The Anglican Church in North America by Crossway a publishing ministry of Good News Publishers. Used by permission. All rights reserved.

What does it say about a training system when childcare can eat up almost half a resident's monthly salary — and the physicians doing essential clinical work have almost no ability to negotiate their pay or benefits? A recent House Judiciary Committee report argues that the Match suppresses resident compensation and bargaining power. But if the Match disappeared tomorrow, would residents actually get paid more? Join Mckenzie Roebuck, Maya Hunt, Nicole Santucci, and Michael Kabbash of CoSEF as they unpack resident pay and benefits, where GME funding actually goes, why residency is not a normal labor market, and where real leverage for change might come from.Hosts: Dr. Mckenzie Roebuck, CoSEF BTK Lead, Inova Fairfax Medical Campus, mckenzie.rowe@inova.org, insta @mrowemd, X @mrowemd1  Dr. Maya Hunt, Indiana University, mayahunt@iu.edu  Dr. Nicole Santucci, Washington University in St. Louis, snicole@wustl.edu  Dr. Michael Kabbash, University of Florida, michel.kabbash@surgery.ufl.edu, X @MichaelKabbash CoSEF: X @surgedfellows, cosef.org Learning objectives: Summarize the congressional report's arguments about resident compensation and bargaining power  Explain how GME funding supports residency and why federal GME dollars do not map directly onto resident salaries  Describe how salary and benefit structures affect residents' financial well-being, family planning, and quality of life  Identify institutional, policy, and collective strategies to strengthen resident compensation and bargaining power.  References: House Committee on the Judiciary. Medical Mis-Match: How a Residency Hiring Monopoly Harms Patients, Doctors, and the American Public. Published online March 27, 2026. Association of American Medical Colleges. AAMC Survey of Resident/Fellow Stipends and Benefits. https://www.aamc.org/data-reports/students-residents/report/aamc-survey-resident/fellow-stipends-and-benefits.  Centers for Medicare and Medicaid Services. Direct Graduate Medical Education (DGME). https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/direct-graduate-medical-education-dgme.  Foote DC, Rosenblatt AE, Amortegui D, et al. Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff. JAMA Netw Open. 2024;7(7):e2421676. doi:10.1001/jamanetworkopen.2024.21676 https://pubmed.ncbi.nlm.nih.gov/39018072/ Tomei KL, Selby LV, Kirk LM, et al. Beyond Training the Next Generation of Physicians: The Unmeasured Value Added by Residents to Teaching Hospitals and Communities. Acad Med. 2022;97(11):1592-1596. https://pubmed.ncbi.nlm.nih.gov/35731593/ doi:10.1097/ACM.0000000000004792 Accreditation Council for Graduate Medical Education. Common Program Requirements. Accessed August 2026.https://www.acgme.org/programs-and-institutions/programs/common-program-requirements/. Rigged or Right? The Residency Match Under Fire | podcast. Behind the Knife. https://behindtheknife.org/podcast/rigged-or-right-the-residency-match-under-fire.  Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewOBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-reviewSurgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-reviewEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

894 Honor the Lord with Substance and Discipline, A Guided Christian Meditation on Proverbs 3:9-12 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable doing so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation Proverbs 3:9-12 NIV 9 Honor the Lord with your wealth,     with the firstfruits of all your crops; 10 then your barns will be filled to overflowing,     and your vats will brim over with new wine. 11 My son, do not despise the Lord's discipline,     and do not resent his rebuke, 12 because the Lord disciplines those he loves,     as a father the son he delights in. RSV 9 Honor the Lord with your substance     and with the first fruits of all your produce; 10 then your barns will be filled with plenty,     and your vats will be bursting with wine. 11 My son, do not despise the Lord's discipline     or be weary of his reproof, 12 for the Lord reproves him whom he loves,     as a father the son in whom he delights. and refreshment to your inner self. Reflection on Scripture: These two stanzas go together well. Let's reflect on the first. What is the purpose of the substance we have? What can our wealth do for us in the long run? What about beyond 100 years? On an eternal scale it is very limited and has no impact other than where we set our heart. If we learn to prioritize God above the things of the world, to include finances, we are in a far better situation to be able to learn what God wants to teach us. I think this message is valuable in times of plenty but in difficult economic times, this message is even more valuable. What would you pay for a better eternal relationship with God? What would someone pay for their own soul? Now the second Stanza, in modern society discipline is often presented as a negative or a necessary evil. And yet the scripture is very pro discipline. I was talking with someone close to me outside my immediate family and I was talking with them about things that werent going the best in their life. I had a very specific moment where I had to decide how truthful to be with them. Not that I had to decide to lie or not, but I had to decide to intentionally bring up uncomfortable conversation that was absolutely not necessary for my happiness. There is a pattern in that person's life I felt I should highlight for them because it was negatively impacting other relationships for them. I remember at that moment specifically choosing to engage in that lengthy emotionally exhausting and uncomfortable conversation because I cared about that person and I wanted them to do well. My willingness to engage in that discomfort was rooted in care. I wanted nothing from that person other than for them to live a more satisfying life for them and for those around them, but I had no expectation the conversation would help me.  The Lord cares for us far more than that. If God chooses to correct us it is not out of an unrighteous desire. It is not out of malice or narcissism or any negative outcome or bias. It is because of his raw care and concern for us. When scripture calls us to repentance or others in our life point out how we could be better, our pride fights it, but God's desire for us is that we rejoice in that correction because it will help us.  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPo

In this episode, Brian and Josh discuss part one of a three part series on motivational interviewing (MI). In this first episode, they review the acronym OARS (Open ended questions, Affirmations, Reflections, Summarize) as a means of understanding a person's motivation to change. The co-hosts examine how sport psychology practitioners, coaches, parents, and others can use these skills in various situations as well as how people can use motivational interviewing strategies with themselves.To learn more about Josh and Brian's backgrounds and sport psychology businesses, go to TiebreakerPsych.com and PerformanceXtra.com. If you have feedback about the show or questions on the mental game in tennis you can email us at tennisiqpodcast@gmail.com. If you're enjoying the show please rate us on your favorite podcast platform including Apple Podcasts and Spotify and write a review. Don't forget to subscribe on YouTube or your podcast platform of choice (Apple Podcasts, Spotify, etc.) to stay up to date on future episodes.

Episode 406 explains how movement prepares the brain but does not guarantee learning. It traces the full sequence—movement, RAS-driven readiness, salience and relevance, focused attention, encoding, retrieval and repetition, and recovery and sleep—that turns activation into lasting memory and performance. The episode offers practical steps in a Move–Focus–Learn protocol: use brief movement to create readiness, clearly identify and remove distractions for one learning target, interact with material in meaningful ways, practice retrieval and spaced repetition, and protect recovery to support consolidation. Listeners are encouraged to test these simple experiments for school, work, or personal learning to make experience more usable and improve attention, memory, and performance. ON THIS EPISODE, YOU'LL LEARN: ✔ Why movement prepares the brain but does not guarantee learning ✔ How attention directs the capacity movement creates ✔ Why meaning and emotional relevance capture attention ✔ The difference between paying attention and actually learning ✔ How retrieval and repetition help new information stick ✔ How seeing, hearing, explaining, and applying an idea can help us remember it ✔ How restorative sleep supports memory and learning ✔ A practical Move–Focus–Learn Protocol for school, work, or your own personal learning The central idea is simple: Movement opens the window. Attention determines what enters. Repetition strengthens what remains. And recovery helps the brain integrate what it has experienced. Welcome back to the Neuroscience Meets Social and Emotional Learning Podcast, where we bridge neuroscience, social and emotional learning, and human performance so we can create measurable improvements in our well-being, achievement, leadership, productivity, and results. I'm Andrea Samadi, and if you've been following along through Season 16, you'll know that we have been building what I call The Brain's Operating System for Human Performance—a neuroscience-based framework designed to help us understand how the different systems of the brain and body work together to influence how we learn, adapt, connect, lead, and ultimately, how we perform. We are currently in Phase 3, focused on Movement, Learning, and Cognition. As I prepared for this phase, I went back through more than 400 episodes of the podcast and organized them according to the five phases of this framework. I wanted to see whether any patterns would emerge. And some did. Phase 1, Regulation and Safety, includes 57 episodes. Phase 2, Neurochemistry and Motivation, includes 41 episodes—the smallest category, possibly because this is the area I have explored the least with my learning. Phase 3, Movement, Learning, and Cognition, includes 174 episodes—the largest category by far. Phase 4, Perception and Social Intelligence, includes 68 episodes. And Phase 5, Integration and Meaning, includes 71 episodes. When I saw that 174 episodes—more than 40 percent of the entire podcast—fit into Movement, Learning, and Cognition, it immediately showed me where much of my curiosity has been directed over the years. I have always been fascinated by learning: How do we prepare the brain to learn? What captures our attention? Why do some ideas (or people) remain with us while others disappear? How does knowledge become something we can retrieve, apply, and actually use to improve our lives? And while I am spending most of my spare time hiking, or at the gym over the years, I wonder, how does this movement that I'm doing help to improve my attention, or memory, and finally, where does recovery fit into this process? The past few weeks, I'm finally connecting the dots with how important recovery is with this equation. I'm also learning how to determine what's important to me. John Medina's Brain Rules book explains what holds our attention. He reminds us that “we don't pay attention to boring things (or people).[i] As we continue through these five phases of The Brain's Operating System for Human Performance, I'm especially curious about how we will move beyond understanding these lessons, to begin implementing what we are learning, and connecting more ways to improve how we learn, adapt, connect, lead, and ultimately perform in our day to day lives. That will become an important part of the upcoming workbook—which is a practical way for each of us to identify what we have already strengthened, where gaps may remain, and which specific actions can help us to improve our own learning, well-being, and performance. Because the purpose of this 5 Phase Framework is not simply to collect more information about the brain. It is to understand how the systems connect—and then use that understanding to create meaningful change.  “Attention Is the Gate—How Movement Becomes Learning.” For today's Episode 406, we'll connect Dr. John Medina's Brain Rules to the Movement Loop we have been building throughout Phase 3—and answer the next important question: Once movement activates and prepares the brain, what determines whether that readiness becomes lasting learning? You can review our full interview with John Medina from EP 42[ii] from February 2020. (find the link in the reference section of the show notes). INTRODUCTION: THE MISSING STEP We have spent this phase so far, examining how movement changes the brain. Dr. Chuck Hillman and Paul Zientarski[iii] showed us that movement prepares the brain for learning. Dr. John Ratey[iv] helped us understand how exercise influences neurochemistry, BDNF, and neuroplasticity. Dr. Kristen Holmes[v] showed us that recovery helps determine whether strain becomes adaptation. And our restorative-sleep episode explored where some of that recovery, adaptation, and integration may occur. But one important question remains: A brain can be activated, chemically prepared, and physiologically ready—but what determines what it actually learns? The answer begins with attention. Movement may create the readiness to learn, but readiness alone is not learning. The brain must still select what matters, focus on it, interact with it, encode it, revisit it, and eventually integrate it. That gives us the pathway we will explore today: Movement creates readiness. But what is the filter in our brain that helps us to focus on the things that are most important to us. What gives us the ability to pay attention to something? The RAS- or The Reticular Activating System. Before we continue, let's remind ourselves what the RAS is. The RAS—or reticular activating system—is a network of neurons extending through the brainstem that helps regulate wakefulness, alertness, and our readiness to respond to incoming information. We explored this system previously in Episode 272, “Priming the Reticular Activating System to Achieve Our Goals.” In that episode, we described the RAS as a type of filter that helps us notice information connected to what we have identified as important. For example, once you decide that you are interested in a particular type of car, you may suddenly begin seeing that car everywhere. That's the RAS filtering system in our brain. The cars were already there, but your attention now has a reason to prioritize them. In Episode 272[vi], we applied this idea to goal-setting. When we clearly identify an intention, we may become more likely to notice relevant information, opportunities, and connections that were previously present but did not receive our attention. That explanation gave us a useful starting point. But here in Episode 406, we can add more precision. The RAS is not a tiny gatekeeper sitting in the brain and personally deciding what we will learn. It is part of a broader network that helps maintain the level of arousal and alertness required for our attention. It helps the brain become available to notice whatever it is that is important to us. Then salience, relevance, emotion, intention, and our current goals help determine what receives priority. Focused attention directs our limited cognitive resources toward the selected information. Next, encoding and repetition help strengthen what we want to focus on. And recovery and sleep help to further support its consolidation and integration. So our expanded Movement Loop now looks like this: you can see an image in the show notes to expand this understanding. Movement supports brain activation.   RAS helps the brain become awake, alert, and ready to pay attention. Salience and relevance (or what matters the most to us) helps to determine what receives priority. Our focused attention selects what gets our priority. Encoding and repetition further strengthens this pathway. Recovery and sleep (that we've dove deep into) support consolidation and integration. And together, these processes increase the likelihood that experience becomes learning—and that learning becomes available for future performance. Whatever it is that we have put our attention on, is now made usable.  This shows us how our understanding has evolved since Episode 272, three years ago. Then, we were asking: How can our intention help us notice what matters with the attainment of our goals? Now, years later, with more understanding, we are asking: Once the brain is alert and something important has captured our attention, what sequence of events must occur for that information to become lasting learning? We are no longer asking only what must remain top of mind so we can notice opportunities connected to our goals. We are asking what happens next: How does something we notice become something we understand? How does something we understand become something we remember? And how does something we remember become knowledge or a skill we can retrieve, apply, and use to improve our performance? This is where Dr. John Medina's Brain Rules help us to connect the pieces. Let's begin with Lesson One: Lesson 1: Movement Creates Readiness—Not Guaranteed Learning Movement can increase alertness, circulation, and readiness for cognitive work. But why might movement have such a powerful relationship with the brain? Dr. John Medina explains this through an evolutionary lens. His point is that the human brain did not develop while we were sitting motionless at desks or staring at screens. It developed while human beings were moving through changing outdoor environments, solving immediate problems, and continually responding to the world around them. Let's listen to how he explains it. CLIP 1 John Medina “The human brain was designed to solve problems related to surviving in an outdoor setting, in unstable meteorological conditions—and to do so in constant motion. The constant motion is where the exercise comes in. But the rest of that—the more a school, or any of us, can recreate the world of the Serengeti, the place where this brain actually grew up, the better things are. And exercise, particularly outdoor exercise, is a terrific example of this idea.” When Medina refers to the Serengeti, I don't think he is suggesting that schools should literally recreate the dangers or conditions of an ancient environment. He is giving us an evolutionary picture of the conditions under which the human brain developed: We moved. We navigated changing environments. We encountered new sensory information. We solved problems. We adapted to uncertainty. And we did these things together rather than remaining physically still for most of the day. Outdoor movement may bring several of these conditions together. We are moving our bodies while also responding to changes in light, temperature, terrain, sound, distance, and direction. This helps explain why movement belongs at the beginning of our Movement Loop. But it also brings us to an important distinction: Movement creates readiness. It does not guarantee learning. A student can move before class and still become distracted. A leader can exercise before work and still spend the morning reacting to notifications. An athlete can warm up physically without becoming mentally focused on the strategy or skill required next. Movement can help activate the system. The RAS in the brain helps us become awake and alert. But the brain must still determine what stands out, what is relevant, and what deserves focused attention. Movement opens the window. Attention determines what enters through it. Our Key lesson: Movement prepares the brain. Attention directs the preparation. PUT THIS INTO ACTION Before your next period of demanding cognitive work, use movement to create a window of readiness. Take a five-to-ten-minute walk, complete a brief movement break, stretch, or choose another form of movement appropriate for your ability and environment. But do not move without deciding what comes next. Before you begin, identify the specific task you will return to: “When this movement break ends, what will receive my attention?” For a student, it might be the first problem on a math assignment. For a leader, it might be the one decision that requires uninterrupted thinking. For an athlete, it might be the cue, strategy, or skill that needs to remain at the center of practice. Movement creates the opportunity. A clear intention helps direct what happens next. Your experiment is: Move briefly, choose one target that you want to complete with this intention, and begin that task immediately after the movement ends. Lesson 2: Attention Is the Gate In EP 395[vii], we examined what captures attention: Meaning Emotion Relevance Intention Reward Human connection Now today's episode shows how we move beyond why the brain notices something and explains what attention does after movement has prepared the system to learn. Attention acts as a filter. The brain encounters more information than it can consciously process, so it must select what receives priority. This creates the bridge: Brain activation creates capacity. Attention distributes that capacity. Our Key lesson: What the brain does not attend to has little opportunity to become lasting learning. Andrea's Application This distinction between brain capacity and cognitive efficiency became personal for me when I reviewed the results of my 2020 brain scan. We covered this topic on EP 84[viii] and we will do a thorough review of what was learned with our brain scans at Dr. Daniel Amen's CA Clinic. The evaluation that I received after my scan was completed with Dr. Shane Creado, suggested that I had areas of strong capacity, but that my brain appeared to be working harder than necessary to complete certain tasks in the cognitive testing. A possible contributor we discussed was sleep deprivation. I want to be careful here: a SPECT scan is not a direct measurement of attention or learning, and my results cannot tell us that insufficient sleep caused a specific attention pattern. But the experience gave me a useful way to think about what we are learning today. Having cognitive capacity does not necessarily mean that we are using that capacity efficiently. I may be motivated, active, and ready to work—but if I am under-recovered, under-slept, distracted, or trying to process too many competing inputs, my brain may have to expend more energy to sustain focus. This helped me understand the Movement Loop at a more personal level: Movement can help activate my brain. Attention gives that activation a target. But recovery may influence how efficiently I can sustain that attention and use it for learning. My scan did not define what my brain could do. It gave me another reason to examine the conditions under which my brain performs at its best. PUT THIS INTO ACTION Before asking yourself—or someone else—to focus, make the target of attention clear. Start by completing this sentence: “The most important thing to notice right now is…” Then reduce the competition around it. We all know to do this. Silence unnecessary notifications. Close unrelated tabs. Remove extra materials from view. Avoid asking the brain to switch repeatedly between tasks. If you are teaching, make the relevance visible: “Why does this matter?” “What should students be listening or looking for?” “How does this connect to something they already know?” If you are working independently, write your one priority clearly where you can see it. Remember, the goal is not to force the brain to attend to everything. The goal is to help it identify (with your RAS-that filter in your brain) what deserves your priority. Your experiment is: Choose one target, (something you want to accomplish) remove as many unnecessary sources of interference as possible, and create one meaningful reason to pay attention. This also helps explain why keeping your desk clear, your closet organized, or your car tidy may make you feel calmer and more focused. How we do anything is how we do everything. Every object, notification, unfinished task, or piece of visual clutter can become another potential signal competing for your attention. That does not mean everything must be perfectly organized before you can begin (while some of us would prefer to work this way), perfection can become its own form of interference. Just get started. It simply means that when you reduce unnecessary visual and mental competition, you make it easier for the brain to recognize the priority in front of you. Clear the space. Name the target. Create the relevance. Then give the task your full attention. Lesson 3: Attention Is Necessary—but It Is Not Enough Paying attention to information once does not guarantee that it will be remembered. This is where Dr. Medina's memory rules enter: Repeat to remember. Remember to repeat. The first refers to giving new information more than one opportunity to be encoded. The second points toward revisiting information over time. This allows you to extend the Movement Loop: Movement prepares the brain and body. Attention selects what to focus on. Retrieval and Repetition strengthens our focus. Recovery helps us to integrate what we are learning. PUT THIS INTO ACTION After learning something new, do not immediately reread it. First, look away from the material and try to retrieve it. Ask yourself: “What were the three most important ideas?” “How would I explain this without looking at my notes?” “What can I remember on my own?” Retrieval reveals the difference between recognizing information and actually being able to access it. Then return to the material, check what you missed, and retrieve it again later—after an hour, the next day, or several days afterward. For students, this could mean closing the textbook and explaining the lesson to a partner. For professionals, it could mean summarizing a meeting before reviewing the notes. For personal learning, it could mean recording a short voice memo explaining the idea from memory. Your experiment is: Learn it once, retrieve it without looking, and schedule a brief return to it later. See if you can remember it. Attention begins the pathway. Retrieval and repetition help strengthen it. Andrea's Application This lesson reminded me of one part of the cognitive testing that accompanied my brain scan at Amen Clinics: a Continuous Performance Test, or CPT. In the version I completed, letters appeared on a computer screen. The instruction was to press a button whenever a letter appeared—except when the letter was X. This type of task may sound simple, but it requires you to remain attentive over time, respond consistently, and inhibit your automatic response when the target letter appears. My results indicated that this was an area in which I did not perform as strongly. Looking back, I remember hearing the basic instruction: press the button for every letter except X. But I do not remember fully appreciating that the speed and consistency of my responses also mattered. This gave me an important real-life lesson: Hearing an instruction is not the same as accurately encoding everything the task requires. Before beginning something important, pause and ask: “What exactly am I being asked to do?” “What details determine successful performance?” “Can I explain the instructions back in my own words?” And, when appropriate, write down the key steps before beginning. This applies in a classroom, during a meeting, while completing an assessment, or whenever accuracy matters. First, attend to the full instruction. Then restate or retrieve it. Clarify anything that is missing. And only then begin the task. My experience showed me that attention is not just about working harder or concentrating more intensely. It is also about identifying the correct target—and making sure we understand the complete task before directing our effort toward it. Lesson 4: Learning Becomes Stronger When It Has More Than One Path Dr. Medina's Brain Rule #9 about sensory integration and vision(meaning our brains learn and remember best when multiple senses—like sight, sound, and touch—are engaged at the same time) give you the practical learning background to involve ALL of your senses. While teaching and learning you can ask: Can I see it? Can I hear it? Can I explain it? Can I demonstrate it? Can I connect it to something I already know? Can I apply it physically or practically? The goal is not sensory stimulation for its own sake. It is to provide clear, relevant pathways through which the learner can interact with the information. Our Key lesson: The more meaningfully we interact with information that we are learning, the more opportunities the brain has to encode and retrieve it. PUT THIS INTO ACTION Choose one idea you want to remember and interact with it in at least two meaningful ways. You might: See it in a diagram. Hear it explained. Say it in your own words. Write or draw it. Teach it to someone else. Demonstrate it physically. Connect it to a previous experience. Or apply it to a real problem. The goal is not to add noise or stimulation. More input is not automatically better. Each interaction should make the idea clearer, more relevant, or easier to retrieve. For example, instead of only reading about the Movement Loop, you could draw the sequence, explain it aloud, and identify where it appears in your own daily routine. Your experiment is: Take one important idea and represent it in two different, meaningful ways. The more deeply we work with information, the more opportunities the brain has to encode and retrieve it. Andrea's Application If you have been listening to this podcast for a while, I'm sure you have noticed that when I organize an idea into a framework—or represent it in a visual graphic—it begins to come to life. I can see how the pieces from past episodes connect, can explain the concept more clearly, and retrieve and apply it to my life more easily. It's also difficult to forget something when there's a visual image connected to it if you are the type of learner who needs to see something to make it stick in your memory. LESSON 5: RECOVERY HELPS LEARNING CONTINUE AFTER ATTENTION ENDS So far, we have followed learning through four important steps: Movement prepares the brain and body. RAS helps “turn on the lights,” allowing us to become awake, alert, and ready to respond. Next, the brain begins identifying what might be important to us. Salience refers to something that stands out—perhaps because it is new, unexpected, emotional, or connected to a possible reward or threat. Relevance refers to how closely that information connects to our goals, needs, experiences, or interests. In simple terms: Salience asks, “What stands out?” Relevance asks, “What matters to me?” Attention through the RAS next directs the brain's spotlight toward the information selected for deeper processing. Imagine a flashlight shining on whatever it is that you have picked to be important to learn. Encoding creates the initial memory. Retrieval and repetition strengthen it. But learning does not necessarily end when we close the book, leave the classroom, finish the meeting, or stop practicing. The brain still needs time to stabilize, organize, and connect what we learned. This is where recovery and sleep enter the Movement Loop. SLEEP IS AN IMPORTANT PART OF LEARNING Sleep is not a period when the brain simply switches off. While we sleep, the brain continues processing information from the day. Newly encoded memories may be reactivated, strengthened, reorganized, and connected with knowledge we already have. This is called memory consolidation. In simple terms, consolidation helps make a new memory more stable and easier to access later. Deep non-REM sleep and REM sleep may support different but overlapping parts of this process. Deep sleep is associated with physical restoration and the consolidation of certain facts and experiences. REM sleep has been associated with emotional learning, procedural skills, creative connections, and integrating new experiences with older memories. But we should not think of these as completely separate jobs. Deep sleep and REM are parts of a repeating sleep cycle, and both may contribute to learning. This is why I use the phrases: Deep sleep helps me recover from the hard work I did that day. REM may help me integrate what I experienced and what it meant to me. The word “may” matters because sleep is more complex than saying that deep sleep only restores the body and REM alone integrates learning. The most important lesson is this: What we focus on while we are awake gives the brain something to work with while we sleep. Retrieval and repetition strengthen the information before sleep. Then sleep provides conditions that can help stabilize, organize, and connect what we learned. THE MOVEMENT LOOP IN SIMPLE TERMS Let's put the complete cognitive side of the Movement Loop into simple language. MOVE—to prepare the brain and body. BECOME READY—RAS- in the brain helps us become awake, alert, and available to respond. NOTICE—salience helps something stand out because it is new, emotional, unexpected, rewarding, or potentially threatening. RELEVANCE—relevance helps the brain recognize how that information relates to our goals, needs, interests, or previous experiences. ATTENTION—directs our mental resources or a spotlight toward the selected information. ENCODE—begins forming a memory of what we are focused on. RETRIEVE AND REPEAT—strengthens the memory and makes it easier to access again. RECOVERY and CONSOLIDATION—so the brain and body can restore, and sleep can support memory consolidation. Leading us to-- INTEGRATION—to connect the new learning with what we already know. APPLY—Making the learning available and ready to use when we need it. So, in its expanded form, the Movement Loop looks like this: Movement → RAS-Supports Readiness → Salience and Relevance (what's important to us)→ Focused Attention → Encoding (forms the memory of what we are focused on)→ Retrieval and Repetition (to strengthen the neural pathway) → Recovery and Consolidation (important for the brain and body to be rested and recovered)→ Integration (connect new learning with what we already know)→ NEW Learning and Performance (ready and available for us whenever we need it). Here is an even easier way to remember how we LEARN: Move. Wake or Get Ready. Notice. Focus. Form a Memory. Strengthen it. Recover it. Connect it. Use it. Movement prepares the system. The RAS helps us become alert. Salience and relevance identify possible priorities. Attention selects the target. Encoding begins the memory. Retrieval and repetition strengthen it. Recovery and sleep help stabilize it. Integration connects it. And application makes it useful. These stages do not always occur in a perfectly straight line. We may notice something before we are fully focused on it. We may need several rounds of encoding and retrieval. We may sleep on an idea and understand it differently the following day. Or we may try to apply what we learned and discover that part of the pathway still needs strengthening. That is why this is a loop rather than a one-way process. Application produces feedback. That feedback shows us what we understand, what we can retrieve and use, and what still requires attention, repetition, or recovery. Then that feedback guides the next cycle of learning. We move again. We become ready. We direct our attention toward what matters. And with each cycle, we build learning that becomes more accessible, adaptable, and useful in our performance. PUT THIS INTO ACTION Before ending your next learning or work session, take one minute to ask: “What is the most important thing I want to remember?” Without looking at your notes, write down the central idea in your own words. Then decide when you will retrieve it again—perhaps later that day or the following morning. After that, give yourself permission to recover. When your attention is fading, another exhausted hour may not be as valuable as a break or a full night of sleep. The following day, try to retrieve the idea again before looking at your notes. Notice what remained accessible and what needs another repetition. Your experiment is simple: Summarize it. Sleep on it. Retrieve it again. Because learning begins while we are awake—but recovery and sleep help the brain continue the work. The Move–Focus–Learn Protocol BRINGING THE FIVE ACTIONS TOGETHER Here is the full Move–Focus–Learn experiment: Test this in school, work or personal learning: Use a brief walk or appropriate movement break before demanding cognitive work. This is what I told Dr. Medina 6 years ago is the only way I'm able to stay focused on writing difficult topics, like this one. Identify the one thing that deserves your attention next. Pick one priority you will focus on. Remove interference. Reduce unnecessary notifications, competing tasks and distractions. This can take a few minutes ahead of time, but keeps the learning slate clean so to speak. Create relevance. Ask, “Why does this matter to me—or to this learner?” Interact with the information you want to learn. Explain it, visualize it, discuss it, demonstrate it or apply it. Retrieve it. Close the book or screen and recall the important ideas without looking. Repeat it later. Return to the information after time has passed. Protect recovery. Allow sleep and recovery to support the next stage of learning. REVIEW AND CONCLUSION As we close out Episode 406, I want to return to the question we began with: Once movement activates and prepares the brain, what determines whether that readiness becomes lasting learning? The answer is not one single process. Learning emerges through a sequence of connected conditions: The brain and body must become ready. Something must stand out and feel relevant. Attention must select it. The information must be encoded. It must be retrieved and revisited. And recovery and sleep must provide opportunities for consolidation and integration. Dr. John Medina's Brain Rules helped us follow this sequence through five key lessons. LESSON 1: EXERCISE PREPARES THE BRAIN Movement helps create biological conditions that support alertness, attention, and cognition. The RAS contributes to this process by helping us become awake, alert, and ready to respond. But movement creates an opportunity—not a guarantee. A prepared brain still needs direction. LESSON 2: ATTENTION SELECTS WHAT MATTERS The brain encounters far more information than it can consciously process. Salience helps us notice what stands out. Relevance connects that information to our goals, needs, interests, or previous experiences. Attention then directs the brain's spotlight toward the selected target. Movement may create greater readiness, but attention determines where that readiness goes. LESSON 3: RETRIEVAL AND REPETITION STRENGTHEN WHAT ATTENTION BEGINS Paying attention once may create familiarity, but familiarity is not the same as learning. Encoding begins the memory. Retrieval asks the brain to locate that information again. Repetition gives us additional opportunities to strengthen our access to it. This is why explaining an idea without looking at our notes can be more useful than simply rereading it. Attention begins the pathway. Retrieval and repetition help make it last. LESSON 4: MEANINGFUL INTERACTION HELPS LEARNING STICK We can strengthen encoding by interacting with an idea in more than one meaningful way. We might see it, hear it, explain it, draw it, demonstrate it, or apply it. The goal is not to add as much stimulation as possible. The goal is to give the brain clear and relevant ways to understand, represent, and later retrieve the information. This is something I have experienced while creating this podcast. When I organize an idea into a framework or bring it to life in a visual graphic, I can see how the pieces connect. That helps me explain the idea more clearly, remember it more easily, and apply it more effectively. LESSON 5: RECOVERY ALLOWS LEARNING TO CONTINUE Learning does not necessarily end when we close the book, leave the classroom, finish the meeting, or stop practicing. During sleep, newly encoded information may be reactivated, stabilized, reorganized, and connected with existing knowledge. Deep non-REM sleep and REM sleep may contribute to this process in different but complementary ways. This is why recovery is not separate from learning. Recovery is part of the learning process. PUTTING THE MOVEMENT LOOP TOGETHER The complete cognitive side of the Movement Loop now looks like this: Movement prepares the brain and body. RAS-supported arousal helps us become awake and alert. Salience and relevance help identify possible priorities. Attention selects the target. Encoding begins the memory. Retrieval and repetition strengthen it. Recovery and sleep support consolidation. Integration connects the new learning with what we already know. And application makes that learning available when we need it. Or, in its simplest form: Move. Wake. Notice. Focus. Form. Strengthen. Recover. Connect. Use. Movement creates readiness. Attention provides direction. Encoding begins the memory. Retrieval and repetition strengthen the pathway. Recovery supports consolidation and integration. And application turns what we have learned into improved performance. Together, these processes help turn activity into lasting learning. FINAL THOUGHT This is not the first time we have explored Dr. John Medina's work, but each return has allowed us to ask a different question. In Episode 42[ix], we asked: How should schools and workplaces change when we understand the brain? In Episode 370[x], we asked: How can neuroscience and emotional regulation improve learning environments? In Episode 395[xi], we asked: What captures attention and motivates behavior? And here in Episode 406, we asked: How does an activated and attentive brain convert an experience into learning? That question has helped us add important detail to the Movement Loop. Movement alone does not create learning. Attention alone does not create lasting memory. Repetition without meaning may not produce understanding. And effort without recovery may not give the brain the conditions it needs to consolidate and integrate what happened. Each part of the process matters. Before we close, consider these questions: What are you preparing your brain to notice? Where is your attention going after you move? Are you interacting with important information deeply enough to encode it? Are you retrieving what you are learning—or merely rereading it? And are you protecting the recovery that allows learning to continue? Because what we repeatedly attend to, retrieve, and apply begins to shape what we know, what we can do, and how we perform. PREPARING FOR EPISODE 407 Movement can prepare the brain. Attention can direct it. Encoding can begin the memory. Retrieval and repetition can strengthen it. And recovery can help consolidate and integrate it. But every part of this process requires energy. The brain needs energy to direct attention, form memories, regulate behavior, and sustain performance. The body needs energy to move, adapt, recover, and begin the cycle again. So in Episode 407, we will revisit Jason Wittrock's work through a more current and carefully defined lens. We'll examine his experience with nutrition and fasting as an applied practitioner and personal case study, while comparing those ideas with current evidence surrounding nutrition, blood-sugar stability, metabolic flexibility, recovery, and performance. Because the brain and body cannot sustain performance without the energy required to power the system. I'll see you next time as we ask: How does metabolic health influence our capacity to move, learn, recover, and perform? RESOURCES Clip 1 with Dr. John Medina https://www.youtube.com/shorts/zDItOHAc8qQ Full Interview with Dr. John Medina https://www.youtube.com/watch?v=CFzg5nQnEMs REFERENCE   [i] John Medina's Brain Rule #4 https://brainrules.net/article/attention/   [ii] Neuroscience Meets Social and Emotional Learning Podcast EPISODE 42 with Dr. John Medina on “Implementing Brain Rules in Schools and Workplaces of the Future” https://andreasamadi.podbean.com/e/dr-john-medina-on-implementing-brain-rules-in-the-schools-and-workplaces-of-the-future/   [iii]Neuroscience Meets Social and Emotional Learning Podcast EPISODE 403 https://andreasamadi.podbean.com/e/movement-first-how-a-20%e2%80%91minute-walk-lights-up-the-brain/     [iv]Neuroscience Meets Social and Emotional Learning Podcast EPISODE 404 https://andreasamadi.podbean.com/e/movement-matters-how-every-move-rewires-the-brain/   [v] Neuroscience Meets Social and Emotional Learning Podcast EPISODE 405 https://andreasamadi.podbean.com/e/movement-isnt-enough-how-recovery-drives-real-adaptation/   [vi]Neuroscience Meets Social and Emotional Learning Podcast EPISODE 272 https://andreasamadi.podbean.com/e/brain-fact-friday-on-priming-the-reticular-activating-system-to-achieve-our-goals-in-2023/   [vii] Neuroscience Meets Social and Emotional Learning Podcast EPISODE 395 https://andreasamadi.podbean.com/e/theory-of-mind-the-missing-link-between-attention-reward-and-motivation/   [viii]Neuroscience Meets Social and Emotional Learning Podcast EPISODE 84  https://andreasamadi.podbean.com/e/how-a-spect-scan-can-change-your-life-part-3-with-andrea-samadi/   [ix] Neuroscience Meets Social and Emotional Learning Podcast EPISODE 42 with Dr. John Medina on “Implementing Brain Rules in Schools and Workplaces of the Future” https://andreasamadi.podbean.com/e/dr-john-medina-on-implementing-brain-rules-in-the-schools-and-workplaces-of-the-future/   [x]Neuroscience Meets Social and Emotional Learning Podcast EPISODE 370 https://andreasamadi.podbean.com/e/brain-rules-revisited-how-neuroscience-can-transform-classrooms/   [xi]Neuroscience Meets Social and Emotional Learning Podcast EPISODE 395 https://andreasamadi.podbean.com/e/theory-of-mind-the-missing-link-between-attention-reward-and-motivation/      

892 Everything We Do, Dear Friends, Is For Your Strengthening, A Guided Christian Meditation on Proverbs 3:3-8 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable doing so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation Proverbs 3:3-8 NIV 3 Let love and faithfulness never leave you;     bind them around your neck,     write them on the tablet of your heart. 4 Then you will win favor and a good name     in the sight of God and man. 5 Trust in the Lord with all your heart     and lean not on your own understanding; 6 in all your ways submit to him,     and he will make your paths straight. 7 Do not be wise in your own eyes;     fear the Lord and shun evil. 8 This will bring health to your body     and nourishment to your bones. NET 3 Do not let mercy and truth leave you; bind them around your neck, write them on the tablet of your heart. 4 Then you will find favor and good understanding, in the sight of God and people. 5 Trust in the Lord with all your heart, and do not rely on your own understanding. 6 Acknowledge him in all your ways, and he will make your paths straight. 7 Do not be wise in your own estimation; fear the Lord and turn away from evil. 8 This will bring healing to your body, and refreshment to your inner self. Reflection on Scripture: I have been thinking a great deal about the state of modern culture. What the mindset of the world is. I have been increasingly confused to see people who profess faith in Jesus become attached to one cultural idea or another in a way that seems to mirror religious devotion. One very profound goal of our meditations can and perhaps should be, to focus on the content of this scripture as a remedy for this idea. What do you hold to with undue ferocity? Perhaps the easy answer is faith in God. There seems to be no major problem with that, provided it doesn't cause us to hate others. It is perfectly acceptable even to maintain a perspective about certain behavior we should aim for, even while refusing to hate others.  I think at all times we should be suspicious of the perspective that the world serves us. Perhaps from the news, politics, social media. Each of these sources are so thoroughly corrupted by the mindset of our fallen world that as believers we should be incredibly hesitant to believe them with anywhere near the ferocity we would place in the God of heaven. A politician should always take a backseat compared to a prophet. Influencers should have far less influence over us than God's word.  At this moment I invite you to sit in calm meditation, carefully examining. May each of us not let mercy and truth leave us. May we have them written on the table of our heart. May we acknowledge that we should hold up God's wisdom above the wisdom of the world. We should be willing, at every moment, to turn from the consensus of the voices of the world and turn toward the wisdom of God who will give us good understanding. May we acknowledge him in every way and may he direct our paths for good.  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

Top 10 AI Prompts for Restaurants Most operators treat AI like a vending machine. Type a question, take whatever falls out. This episode argues the opposite. Dave, Brian, and Anthony make the case that AI is a brain you train like a new hire, not a search bar you poke once. Feed it context, correct it, be patient with it, and it starts to sound like you and think like your operation. Appropriate use makes you look like a genius. Lazy use makes you look like a dumbass. The payoff is a rapid-fire set of prompts you can steal and run this week, from turning a rambling voice memo into clean menu copy to roleplaying a guest complaint before your manager ever faces one live. The bigger idea underneath it all: don't chase saved time for its own sake. Use the time AI gives back to elevate your game. The 10 prompts: 1. Turn a rambling voice memo of this week's specials into a clean menu description. 2. Write three social captions for tonight's event in our voice: casual, local, not corporate. 3. Draft a calm reply to this one-star review that de-escalates without groveling. 4. Build a prep checklist for a new line cook's first Friday night. 5. Give me five specials I can run this week using the ingredients I'm overstocked on. 6. Write a job post for a server that filters for hospitality attitude over experience. 7. Turn our opening and closing routine into a printable SOP a 17-year-old could follow. 8. Draft a re-engagement text to regulars I haven't seen in 30 days, warm and not desperate. 9. Summarize this vendor contract and flag anything that locks me in or auto-renews. 10. Roleplay a tough guest complaint so I can practice how my manager should handle it. Also covered: building projects and workflows so AI runs the same task the same way every time, a near-free Power BI dashboard pulling point of sale and payroll data for daily reporting, an overnight review-monitoring routine across Google and other sites, and why experienced operators are the ones best positioned to catch a bad AI answer. A note on browser automation: the hosts discuss letting AI operate inside a Chrome tab, including clicking through screens and logging into accounts on your behalf. Handle this with care. Granting an AI access to your logins and systems carries real security risk. Use it at your own discretion, keep your credentials protected, and understand what you are authorizing before you turn it loose. Tools mentioned: Claude, ChatGPT, and Microsoft Power BI. Tell us your favorite prompts and how you're using AI in your restaurant. Follow us and send feedback at restauranttopia.com, and subscribe wherever you listen. Featuring Dave Ross, Brian Seitz, and Chef Anthony Hamilton. Learn more about your ad choices. Visit megaphone.fm/adchoices

Multiple endocrine neoplasia (MEN) refers to a group of rare inherited syndromes that increase the risk of developing tumors in multiple endocrine organs. MEN affects men and women at roughly equal rates and occurs across geographic, racial, and ethnic groups. These syndromes are caused by genetic mutations inherited in an autosomal dominant pattern, meaning an affected parent has a 50% chance of passing the mutation to each child. Unlike many sporadic cancers, tumors associated with MEN often develop at a younger age and may involve several endocrine organs over a patient's lifetime. In this AudioBrick, we review the three major MEN syndromes—MEN1, MEN2A, and MEN2B—including their characteristic tumors, genetic causes, clinical features, and management. After listening to this AudioBrick, you should be able to: Define multiple endocrine neoplasia and identify the three major MEN syndromes. Compare the key clinical features of MEN1, MEN2A, and MEN2B. Describe the genetic mutations associated with each syndrome. Summarize the basic approach to management and surveillance. You can also explore the original Multiple Endocrine Neoplasia Rx Brick from our Endocrine collection, available free here: https://usmle-rx.scholarrx.com/rx-bricks/brick/CP_END0028 (opens in new tab) Want to explore more Rx Bricks and other USMLE-Rx study tools? Start a free USMLE-Rx trial: https://www.usmle-rx.com/ (opens in new tab) Your trial includes access to Rx360+, including Rx Bricks, Qmax, and other resources designed to help you prepare for the USMLE and COMLEX exams. If you enjoyed this episode, please consider leaving a review on Apple Podcasts: https://podcasts.apple.com/us/podcast/the-rx-bricks-podcast/id1530646481(opens in new tab) Your reviews help other medical students discover the podcast and support our goal of making high-quality medical education more accessible. Follow USMLE-Rx: Facebook: https://www.facebook.com/usmlerx (opens in new tab) Instagram: https://www.instagram.com/USMLE_rx_ (opens in new tab) X: https://x.com/USMLE_rx_ (opens in new tab)Threads: https://www.threads.net/@USMLE_rx_(opens in new tab)BlueSky: https://bsky.app/profile/usmle-rx.bsky.social(opens in new tab)TikTok: https://www.tiktok.com/@USMLE_rx_(opens in new tab)YouTube: https://www.youtube.com/USMLERX USMLE-Rx Blog: https://usmle-rx.com/blog-posts/(opens in new tab)

Dr. Donn Posner is a leading expert in Cognitive Behavioral Therapy for Insomnia (CBT-I), founder and president of Sleepwell Consultants, and an adjunct clinical associate professor in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. He is co-author of Cognitive Behavioral Therapy for Insomnia: A Session-by-Session Guide, and he has trained and consulted with clinicians nationally and internationally across nearly four decades of clinical practice. In this second of two episodes, the conversation turns from what CBT-I is to how clinicians actually learn and deliver it. Dr. Posner reviews the available training pathways and what proficiency really requires, and explains why sleep hygiene — the advice most patients have already heard many times over — does not treat chronic insomnia, even though it has a place later in the work. He identifies the high-yield principles any clinician can apply immediately, including a fixed morning wake time, early light exposure, and getting out of bed when not sleeping. He then examines sleep effort as a perpetuating factor and CBT-I as fundamentally a therapy of acceptance, describing how he prepares patients for a treatment that will make them feel worse before it makes them better, and how cognitive work addresses the fear and resistance that follow. He closes with what clinicians should expect from a course of treatment — typical length and spacing, responder and remitter outcomes, and the durability of gains — along with how he handles sleep medication and why guidelines place CBT-I ahead of hypnotics.Learning ObjectivesAfter completing this educational activity, participants should be able to:Explain why sleep hygiene is ineffective as a monotherapy for chronic insomnia, and describe the more limited role it plays within a full course of CBT-I.Identify high-yield behavioral sleep medicine principles — including a fixed morning wake time, early light exposure, and getting out of bed when not sleeping — that clinicians can apply before completing formal CBT-I training.Describe sleep effort as a perpetuating factor, and summarize how the cognitive and acceptance-based components of CBT-I address the dysfunctional beliefs and resistance that arise during treatment.Summarize the expected course and outcomes of CBT-I (including typical session number and spacing, responder and remitter outcomes, and durability of gains) and explain why guidelines position CBT-I ahead of hypnotic medication.Topics Covered in This InterviewPathways to training in CBT-I and behavioral sleep medicineBoard certification in behavioral sleep medicineWhy sleep hygiene alone does not treat chronic insomnia: the dental hygiene analogyWhere sleep hygiene does belong within CBT-IAvailable CBT-I training programs and online optionsHow clinicians become proficient: consultation, community, and case experienceHigh-yield behavioral sleep principles any clinician can applySleep regularity, fixed wake times, and morning light exposureWhy getting out of bed is the hardest intervention for patients to acceptSleep effort as a perpetuating factorWhat good sleepers do — and do not do — to fall asleepCBT-I as a therapy of acceptancePreparing patients for the work: “I'm going to make you worse before I make you better”The cognitive component: uncovering and debunking dysfunctional beliefsCommon patterns of resistance, and exposure as the remedyTypical treatment length, session spacing, and pacingResponders versus remitters, and what the outcome data showDurability of gains and the role of sleep self-efficacyManaging and tapering sleep medication alongside CBT-IWhy guidelines position CBT-I ahead of hypnotic medication

890 I Spend My Life in God's Service, A Guided Christian Meditation on 2 Corinthians 12:14-16 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable doing so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation 2 Corinthians 12:14-16 KJV 14 Now I am ready to come to you this third time. And I will not be a burden, for I want not what is yours, but you. Children ought not to save for their parents, but parents for their children. 15 I will most gladly spend and be utterly spent for your sakes. If I love you more, am I to be loved less? 16 But granted that I myself did not burden you, yet I was crafty and got the better of you by deceit. 14 Look, for the third time I am ready to come to you, and I will not be a burden to you, because I do not want your possessions, but you. For children should not have to save up for their parents, but parents for their children. 15 Now I will most gladly spend and be spent for your lives! If I love you more, am I to be loved less? 16 But be that as it may, I have not burdened you. Yet because I was a crafty person, I took you in by deceit! Reflection on Scripture: I was counseling with a person one time and they felt devalued by their spouse and they were talking about prioritizing themselves more. I have heard this repeated often. In that moment, I felt an internal conflict, or perhaps better said I felt the weight of the balance that Paul presents in these previous verses regarding his equality with other apostles. On the one hand he is no less valuable, and on the other, he is equally a fallen person.  So one side is that we need to learn to not hate ourselves because that is a lie from the enemy, yet the solution to that is not to focus more on ourselves that is an influence from our unhealthy culture. Jesus taught us to love and serve others. He also told us to love others as ourselves. Other people are no more important but no less important than you are. I don't think in general the world has a shortage of people thinking about themselves. Learning to focus more on ourselves is often not the way to resolve these feelings. If we are willing to serve God would that also not be serving God's children.  I think the solution to feeling devalued is to truly understand the value God places in us and now that we feel His love, that we look to Jesus for what he wants us to do with this stronger feeling of value and love. As two examples, consider a situation in which both people in a marriage feel as though they are not being focused on and loved enough. It is possible for both people to feel devalued at the same time. The solution to this problem would not be for both partners to focus on themselves more, but to learn how to receive unconditional love from God. Once fed by the love of God we can help to more clearly connect with another person and appropriately negotiate with our spouse on how to feel more loved from them. This is a profound oversimplification but consider it a metaphor.  Another example is for people who struggle with social anxiety, if we transition to helping other people feel at ease in social settings it can actually lower our anxiety more than trying to put ourselves at ease. Again both of these are oversimplifications but they are examples. So take Pauls statement here about how he remains dedicated to the Church and try and discern how God wants you to balance your dedication?  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

Want to hear the latest on psoriasis research? We've got just the expert. This week, we're joined by Dr. Wilson Liao as he as he explores emerging science, clinical challenges, and integrative care strategies to bridge the gap between research and practice in psoriasis management. Dr. Wilson Liao is Professor of Dermatology and Director of the Psoriasis Center at the University of California San Francisco. Dr. Liao is a dermatologist with expertise in biologic therapy and phototherapy and human geneticist who has contributed to the identification of over 60 psoriasis susceptibility genes. He has led numerous genetic, transcriptomic, proteomic, and microbiome studies in psoriasis. Dr. Liao's group has also investigated the impact of environmental factors on psoriasis, including diet, stress, exercise, sleep, and pollution. He currently serves as a member of the National Psoriasis Foundation Medical Board and Scientific Advisory Committee.  Learning Objectives: a) Summarize key advances in psoriasis immunopathogenesis and targeted therapies. b) Apply evidence-based approaches to integrating emerging treatments and integrative care in clinical practice. c) Identify strategies for comorbidity management and patient-centered communication Each Thursday, join Dr. Raja and Dr. Hadar, board-certified dermatologists, as they share the latest evidence-based research in integrative dermatology. For access to CE/CME courses, become a member at LearnSkin.com. To learn more about Psoriasis, visit LearnSkin.com to enroll in the  Advancing Clinician Competence in Psoriasis and Psoriatic Arthritis Management: Emerging Immune Pathways and Integrative Care. In collaboration with the National Psoriasis Foundation and supported by independent educational grants from AbbVie, Johnson & Johnson, Ortho Dermatologics, Sun Pharmaceutical Industries, Inc, Takeda Pharmaceuticals U.S.A., Inc and UCB

In children with septic shock, does the choice between balanced crystalloids and 0.9% saline actually matter? This episode reviews the composition and physiologic differences between commonly used crystalloids, summarizes the 2026 PRoMPT BOLUS trial, and discusses how its findings fit with the updated Surviving Sepsis Campaign pediatric guidelines. We also consider the trial's limitations and what the results mean for fluid selection at the bedside. Learning Objectives By the end of this episode, listeners should be able to: Compare the composition and physiologic effects of 0.9% saline and balanced crystalloids used for pediatric fluid resuscitation. Summarize the design and major findings of the PRoMPT BOLUS trial. Describe important limitations of PRoMPT BOLUS when applying its results to children with septic shock. Apply current evidence and 2026 Surviving Sepsis Campaign recommendations when selecting crystalloid fluids for pediatric septic shock. References Weiss SL, Peters MJ, Oczkowski SJW, et al. Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026. Pediatr Crit Care Med. 2026. Published April 1, 2026. Jointly issued by the Society of Critical Care Medicine and Infectious Diseases Society of America. Recommendation 24 suggests balanced/buffered crystalloids over 0.9% saline for children with septic shock requiring fluid boluses (conditional recommendation, very low certainty), while recognizing 0.9% saline as a suitable alternative and preferred in selected situations such as hyponatremia or concern for increased intracranial pressure. Balamuth F, Weiss SL, Long E, et al. Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock. N Engl J Med. 2026. Published April 24, 2026. PRoMPT BOLUS was a large pragmatic randomized trial comparing balanced crystalloids with 0.9% saline in children treated for suspected septic shock and found no reduction in major adverse kidney events within 30 days with balanced fluids. Transcript This transcript was generated using Descript and subsequently reviewed and lightly edited for spelling, grammar, and clarity. Minor inaccuracies may remain, and the audio recording should be considered the definitive version of this content. Welcome to PEM Currents: The Pediatric Emergency Medicine Podcast. As always, I'm your host, Brad Sobolewski, and today we're gonna talk about which fluid we should use when managing a septic pediatric patient. So when we resuscitate a child with septic shock, the major decision is usually not whether to give crystalloid, but which crystalloid to give. And for a long time, there's been a gradual shift towards balanced fluids such as Lactated Ringer's or Plasma-Lyte, largely because they are more physiologic and produce less hyperchloremia than normal saline. The question's always been whether those biochemical differences actually translate into better clinical outcomes. That is the question that a study called PRoMPT BOLUS was designed to answer. So before getting into the trial, it's worth briefly reviewing what these fluids actually contain. So normal saline is 0.9% sodium chloride. It contains one hundred and fifty-four milliequivalents per liter of sodium and a hundred and fifty-four milliequivalents per liter of chloride. The chloride concentration is substantially higher than plasma. Balanced crystalloids contain less chloride and have some other electrolytes and a buffer. Lactated Ringer's contains approximately a hundred and thirty milliequivalents per liter of sodium, one hundred and nine of chloride, four of potassium, a small amount of calcium, and lactate as a buffer. Plasma-Lyte contains approximately one hundred and forty of sodium, ninety-eight of chloride, five of potassium, magnesium, and acetate and gluconate as buffers. The concern with normal saline is that the large chloride loads can produce hyperchloremic metabolic acidosis. There's also been concern about adverse effects on renal blood flow and kidney function. Balanced fluids are designed to more closely approximate plasma composition, so the hypothesis has been that they might reduce kidney injury. That hypothesis has been supported by physiologic data and by some adult studies, although pediatric evidence before PRoMPT BOLUS was limited and inconsistent. The 2026 Surviving Sepsis Campaign Pediatric Guidelines recommend crystalloids over albumin for initial resuscitation and conditionally suggest balanced or buffered crystalloids over 0.9% saline in children with septic shock who require fluid boluses. Importantly, that recommendation is based on very low-certainty evidence. Balanced options again include Lactated Ringer's, Hartmann's solution, or Plasma-Lyte. If balanced fluids are not readily available, saline remains an acceptable alternative. Saline may also be preferable in some specific situations like significant hyponatremia or concern for increased intracranial pressure. For children in resource-abundant settings, the general approach is still ten to twenty mLs per kilo per bolus with reassessment after each bolus, potentially up to forty to sixty mLs per kilo in the first hour if perfusion remains abnormal and there are no signs of fluid overload. Now, PRoMPT BOLUS, the full name of which is the Pragmatic Pediatric Trial of Balanced versus Normal Saline Fluid in Sepsis, was an international randomized pragmatic trial designed to specifically compare the two fluid strategies in children with suspected septic shock. The final trial enrolled nine thousand and forty-one children from two months to younger than eighteen years across forty-seven emergency departments in five countries. Children were randomized to predominantly balanced crystalloid or predominantly 0.9% saline, and the assigned fluid strategy was used for bolus and maintenance crystalloid during the initial treatment period. The balanced fluid arm was not a single product. Depending on the site, children could get Lactated Ringer's, Hartmann's solution, or Plasma-Lyte. That's important when interpreting the study. PRoMPT BOLUS was really testing a strategy of predominantly balanced crystalloid versus a strategy of predominantly saline use rather than comparing LR versus saline alone, though LR was the most commonly used one. The primary outcome was something called MAKE30, M-A-K-E thirty, or major adverse kidney events within thirty days. This was a composite outcome that included death, new renal replacement therapy, or persistent kidney dysfunction. That choice of outcome is useful because the biologic rationale for balanced fluids has always centered largely on kidney protection. The investigators were therefore asking whether the lower chloride exposure associated with balanced fluids translated into clinically meaningful renal benefit. So what was the result? Well, the spoiler is that the answer was no. So MAKE30 occurred in three point four percent of children receiving balanced fluids and three percent receiving saline. The relative risk was one point one with a ninety-five percent confidence interval from point eight eight to one point four. There were also no significant differences in death, new renal replacement therapy, persistent kidney dysfunction, or hospital-free days. In practical terms, balanced crystalloids did not improve the major patient-centered outcomes the trial was designed to measure. There were clear biochemical differences between the groups. Hyperchloremia occurred in thirty-one point four percent of children receiving balanced fluids compared with forty-nine percent with saline. Hypernatremia was also less common with balanced fluids, one point eight versus three point one percent. Hyperlactatemia was slightly more common in the balanced fluid group, nineteen point eight compared with sixteen point seven percent. So the fluids behaved differently in the ways that you would expect physiologically. Balanced crystalloids clearly reduced hyperchloremia, but that difference did not translate into fewer major kidney events, less dialysis, shorter hospitalization, or lower mortality. There are several limitations to this study worth keeping in mind. The first is that this was a broad emergency department population with suspected septic shock, not a study limited to children with the most severe forms of shock. Only a minority of patients required vasoactive medications, and overall mortality was low. The results are therefore most applicable to the typical child with suspected septic shock receiving early ED resuscitation. They do not completely answer whether fluid composition might matter more in a smaller subgroup of children receiving very large fluid volumes or prolonged resuscitation. The second limitation is that the event rate for MAKE30 was lower than expected. When the trial was designed, investigators anticipated an event rate of about six percent in the saline group. The observed rate was closer to three percent. That means there were fewer outcome events than anticipated, which reduced the ability to detect a very small treatment effect. So the trial makes a large benefit from balanced fluids unlikely, but it can't exclude a small or subtle difference. A third limitation is that the balanced fluid group included several different solutions. Lactated Ringer's, Plasma-Lyte, and Hartmann's are all considered under the umbrella of balanced crystalloids, but they're not chemically identical. The study therefore supports the broader conclusion that a balanced fluid strategy is not superior to saline for most children in this setting, rather than providing equivalence between any single specific balanced solution and saline, even though Lactated Ringer's is used far and away most often. The trial was also intentionally pragmatic, which means that there was some crossover between fluid types. Adherence was defined as receiving at least seventy-five percent of crystalloid as the assigned fluid rather than requiring exclusive use of one fluid. That could reduce the ability to detect a small treatment effect, but it also makes the study more reflective of real clinical practice. The investigators themselves described the trial as a comparison of predominant rather than exclusive use of balanced crystalloids versus saline. Finally, the trial was open label, so clinicians knew which fluid the child was receiving. That introduces the possibility of treatment bias, though the primary outcome relied on relatively objective measures. A substantial proportion of children also did not have a measured baseline creatinine, so baseline kidney function sometimes had to be imputed using age- and sex-based values. That's worth remembering because persistent kidney dysfunction was part of the primary composite outcome. Taken together, I think PRoMPT BOLUS makes the bedside decision simpler. Balanced fluids remain a completely reasonable and defensible choice. They cause less hyperchloremia, and there's no reason to abandon them if they're already part of your usual resuscitation fluid strategy or your order sets. At the same time, the largest pediatric randomized trial now shows no improvement in major kidney or mortality outcomes compared with normal saline. So if you use saline at your local hospital, that's okay too. The 2026 Surviving Sepsis Campaign still conditionally favors balanced crystalloids, but that recommendation is based on very low-certainty evidence. So PRoMPT BOLUS adds important randomized data suggesting that for most children with septic shock, either crystalloid strategy is reasonable. The practical takeaway is that the choice of crystalloid is probably less important than getting the resuscitation itself right. Give 10 to 20 mLs per kilo when a fluid bolus is indicated, reassess frequently, watch for improvement in perfusion and for signs of fluid overload, and move to vasoactive support when fluid alone is not correcting the shock. Balanced crystalloids will produce less hyperchloremia. Normal saline will produce more. In PRoMPT BOLUS, that biochemical difference did not translate into a difference in kidney injury, dialysis, or mortality. For most children with septic shock, balanced fluids are fine, normal saline is fine, and timely, thoughtful resuscitation matters much more than which bag is hanging. I hope you found this episode on fluids for sepsis in children helpful and that you'll be able to take this knowledge back to the bedside the next time you work in the emergency department. If you've got other topics you want me to cover, especially as they relate to practice-changing research in pediatrics, like the PRoMPT BOLUS trial from the Pediatric Emergency Care Applied Research Network, PECARN as we call it, let me know. Send it my way. If you have time to leave a review on your favorite podcast site, please do so. It helps other people find the show, and definitely share this with your colleagues. I think this study and perhaps this podcast episode could be a great combo for an upcoming journal club. For PEM Currents, the Pediatric Emergency Medicine Podcast, this has been Brad Sobolewski. See you next time.  

888 My Grace Is Sufficient, A Guided Christian Meditation on 2 Corinthians 12:7-10 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable doing so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation 2 Corinthians 12:7-10 KJV 7 And lest I should be exalted above measure through the abundance of the revelations, there was given to me a thorn in the flesh, the messenger of Satan to buffet me, lest I should be exalted above measure. 8 For this thing I besought the Lord thrice, that it might depart from me. 9 And he said unto me, My grace is sufficient for thee: for my strength is made perfect in weakness. Most gladly therefore will I rather glory in my infirmities, that the power of Christ may rest upon me. 10 Therefore I take pleasure in infirmities, in reproaches, in necessities, in persecutions, in distresses for Christ's sake: for when I am weak, then am I strong. ESV 7 So to keep me from becoming conceited because of the surpassing greatness of the revelations, a thorn was given me in the flesh, a messenger of Satan to harass me, to keep me from becoming conceited. 8 Three times I pleaded with the Lord about this, that it should leave me. 9 But he said to me, "My grace is sufficient for you, for my power is made perfect in weakness." Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me. 10 For the sake of Christ, then, I am content with weaknesses, insults, hardships, persecutions, and calamities. For when I am weak, then I am strong. Reflection on Scripture: Today I gave an invocation prayer for an event for an organization that supports military service members. The person who runs it has done some really amazing things for the servicemembers I have worked with in the past so I was glad to support. The main speaker was a man who served in Vietnam in many incredibly brutal situations. He had led his men in combat and now was telling some of these stories for the first time ever. He was a powerful speaker but it was clear he was working through challenging memories. He was very determined but each person, regardless of their strength, struggles with things. Most of the time we have no decision or input on what thing it is that will challenge us most. This man harnessed that fear of telling his story resulting in a profoundly moving speech.  Paul was not immune to having struggles and even one that he felt extremely vexed by. Paul had amazing visions and gifts from God, and yet he struggled in ways that had him imploring God for help. And yet God did not give it in the way that Paul asked for. Without even knowing yoru situation I can guess that you have things that at times feel heavy for you to bear. Perhaps that is rare or incredibly frequent. If you are being honest though you have troubles. This is the message from God. Use that weakness to draw you closer to God and accept that all things can work together for the good of those who love God.There can be strength in that weakness. It reminds us of our need for God. God's strength is made perfect in our weakness. WE are shown the Mercy of God most when we need it. We may be a way off from what  Many times we see only struggle and we dont see the good it does in us. Embrace the truth Paul teaches. WE can rejoice in the perfection of God. Just because you don't get to choose your struggle doesn't mean you have no choice in how to work through it. The resounding solution to that question is found in this scripture. Trust God. Lean on His strength and He will make you stronger than you could imagine  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

Interest in functional medicine and direct-to-consumer diagnostic testing continues to grow, shaping how many patients think about prevention, wellness, and chronic disease management. This course explores key concepts in functional medicine and examines how pharmacists can thoughtfully evaluate these approaches through an evidence-based lens. You will gain practical insight to support informed patient conversations while maintaining professional standards and scope-appropriate care.HOSTRachel Maynard, PharmDGameChangers Podcast Host and Lead, Clinical & Partnership Education, CEimpactGUESTJosie Ross, Pharm DPICPhillips Family Pharmacy and CompoundingPharmacists, REDEEM YOUR CPE HERE!CPE is available to Health Mart franchise members onlyTo learn more about Health Mart, click here: https://join.healthmart.com/PRACTICE RESOURCEReceive the exclusive Practice Resource to use as a reference guide for this episode by enrolling in the course. Click here to enroll!CPE INFORMATION Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Describe foundational principles of functional medicine and their relevance to evidence-based care in pharmacy.2. Summarize factors pharmacists should consider when evaluating the evidence supporting functional medicine approaches.Rachel Maynard and Josie Ross have no relevant financial relationships to disclose.0.05 CEU/0.5 HrUAN: 0107-0000-26-308-H01-P Initial release date: 8/17/2026Expiration date: 8/17/2029Additional CPE details can be found here.

Interest in functional medicine and direct-to-consumer diagnostic testing continues to grow, shaping how many patients think about prevention, wellness, and chronic disease management. This course explores key concepts in functional medicine and examines how pharmacists can thoughtfully evaluate these approaches through an evidence-based lens. You will gain practical insight to support informed patient conversations while maintaining professional standards and scope-appropriate care.HOSTRachel Maynard, PharmDGameChangers Podcast Host and Lead, Clinical & Partnership Education, CEimpactGUESTJosie Ross, Pharm DPICPhillips Family Pharmacy and CompoundingGET CE FOR LISTENING!Stay Compliant. Grow Clinically. Practice with Confidence. Pharmacist CE Subscription: All your CE in one convenient subscription.All episodes, CE, and Practice Resources for the GameChangers Clinical Update is included with your Pharmacist CE Subscription. But wait…there's even more!The Pharmacist CE Subscription includes: -  Compliance and licensure CE -  GameChangers Clinical Updates-  Practical continuing education across patient care topics *The subscription does not include microcredentials or certificates, which are available separately for pharmacists seeking specialized service training. Purchase Now!PRACTICE RESOURCEReceive the exclusive Practice Resource to use as a reference guide for this episode by purchasing the Pharmacist CE Subscription. CPE REDEMPTIONThis course is accredited for continuing pharmacy education! Click the link below that applies to you to take the exam and evaluation to claim credit:If you are already enrolled in this course, click here to redeem your credit. To purchase the Pharmacist CE Subscription and claim your CPE credit, click here or to purchase this course individually, click here.  CPE INFORMATIONLearning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Describe foundational principles of functional medicine and their relevance to evidence-based care in pharmacy.2. Summarize factors pharmacists should consider when evaluating the evidence supporting functional medicine approaches.Rachel Maynard and Josie Ross have no relevant financial relationships to disclose.0.05 CEU/0.5 HrUAN: 0107-0000-26-308-H01-P Initial release date: 8/17/2026Expiration date: 8/17/2029Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagram

886 We Have Heard For Ourselves, A Guided Christian Meditation on John 4:37-42 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable doing so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation John 4 NIV 39 Many of the Samaritans from that town believed in him because of the woman's testimony, "He told me everything I ever did." 40 So when the Samaritans came to him, they urged him to stay with them, and he stayed two days. 41 And because of his words many more became believers. 42 They said to the woman, "We no longer believe just because of what you said; now we have heard for ourselves, and we know that this man really is the Savior of the world." RSV 39 Many of the Samaritans of that town began to believe in him because of the word of the woman who testified, "He told me everything I have done." 40 When the Samaritans came to him, they invited him to stay with them; and he stayed there two days. 41 Many more began to believe in him because of his word, 42 and they said to the woman, "We no longer believe because of your word; for we have heard for ourselves, and we know that this is truly the savior of the world." Reflection on Scripture: The Samaritan woman at the well shared her simple faith in Jesus. That was enough to peak the interest of the whole location where she lived. Yet it was not this testimony that saved. It was Jesus. His presence. His spirit. His words. When the people had heard Jesus themselves, then they came to understand and have faith. Then they heard it for themselves. This is what we all need. As you spend time in scripture, in prayer, in worship, in meditation, you turn your attention from just hearing other people's experience with God and you begin to have your own, or you deepen your own experience. No matter who you are and what spiritual connection you have had with God, to get lax in this area. When this happens we miss out on the beauty and peace that come from proximity to the influence of God's word in our life.  Why on earth would we not graciously drink from the cool water of life that God offers. God offers you His love? How often do you drink of it? How often do you let it flow by without savoring it? Do you constantly feed your faith in God with deep and meaningful personal experience with God's spirit and His words? Go to the source of truth, the source of peace, the source of power and strength.  Take this mediation as a recommittal to spend time with God. Don't outsource your faith. Don't defer what you hold to be true to someone who had their own spiritual experience. Go to God. Go to His word. Go to God in prayer. By all means learn from the wise and learned people, but your faith must grow from within you. The fact that someone else has profound knowledge that has fed their own faith will not be enough for you until you put your focus to grow the roots of your own faith deeper inside of yourself. THen as that faith grows you can constantly nourish it with more knowledge from wise sources.  Many times we see  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

Digital surgery has morphed from buzzword into ubiquitous high-impact technology. In this episode, the BTK MIS team steps into the rapidly evolving ecosystem of cameras, sensors, robotics, and software that are turning surgical operations into structured, analyzable datasets. From AI segmentation to real-time telepresence, don't miss this opportunity to catch up on what's new and what's next, what's exciting and what's terrifying, just on the horizon of your surgical career. Hosts: ·      James Jung, MD, PhD, Assistant Professor of Surgery, Duke University·      Jacob Greenberg, MD, EdM, MIS Division Chief and Vice Chair for Education, Duke University·      Zachary Weitzner, MD, Minimally Invasive and Bariatric Surgery Fellow, Duke University, @ZachWeitznerMD·      Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actuallyLearning Goals: By the end of this episode, listeners will be able to:·      Define “digital surgery” and describe its core components, including video capture, instrumentation, robotics, data analytics, and system connectivity. ·      Discuss current and emerging applications of digital surgery in surgical education, including video-based self-assessment, procedural segmentation, and structured feedback models. ·      Describe how digital tools can be used to improve OR efficiency and resource utilization, including instrumentation usage, operative time analysis, and workflow optimization. ·      Summarize current telepresence and teleproctoring technologies and their clinical use cases, including augmented reality–based collaboration across institutions and geographic boundaries. ·      Identify key ethical, legal, and operational challenges in digital and tele-surgery, including credentialing, cross-state licensure, liability, and trust in remote expertise. ·      Discuss how digital surgery may reshape surgical training and competency-based assessment, including implications for autonomy, deliberate practice, and feedback frequency. ·      Recognize future directions of digital surgery integration, including predictive analytics, simulation using patient-specific imaging, and AI-assisted intraoperative decision support.References:  Balvardi S, Semsar-Kazerooni K, Kaneva P, et al. Validity of video-based general and procedure-specific self-assessment tools for surgical trainees in laparoscopic cholecystectomy. Surg Endosc. 2023;37(3):2281-2289. doi:10.1007/s00464-022-09466-6 [https://pubmed.ncbi.nlm.nih.gov/36307525/] Hospital Utilizes Intraoperative Idle Time Metrics to Improve Surgical Safety and Efficiency. Theator | The Surgical Intelligence Company. Accessed March 20, 2026. https://theator.io/customer-story/hospital-utilizes-intraoperative-idle-time-metrics-to-improve-surgical-safety-and-efficiency/ Campbell KK, Abreu AA, Zeh HJ, et al. Using OR Black Box Technology to Determine Quality Improvement Outcomes for In-situ Timeout and Debrief Simulation. Ann Surg. 2026;283(1):122. doi:10.1097/SLA.0000000000006438 [https://pubmed.ncbi.nlm.nih.gov/38317208/] Al Abbas AI, Meier J, Daniel W, et al. Impact of team performance on the surgical safety checklist on patient outcomes: an operating room black box analysis. Surg Endosc. 2024;38(10):5613-5622. doi:10.1007/s00464-024-11064-7 [https://pubmed.ncbi.nlm.nih.gov/39069926/] Proximie's telepresence platform helps surgeons across the globe grow and exchange experience in real-time. World Health Expo Insights. Accessed March 20, 2026. https://www.worldhealthexpo.com/insights/telemedicine/proximie-s-telepresence-platform-helps-surgeons-across-the-globe-grow-and-exchange-experience-in-real-time Hassan AE, Desai SK, Georgiadis AL, Tekle WG. Augmented reality enhanced tele-proctoring platform to intraoperatively support a neuro-endovascular surgery fellow. Interv Neuroradiol. 2022;28(3):277-282. doi:10.1177/15910199211035304 [https://pubmed.ncbi.nlm.nih.gov/34538166/] SAGES Digital Surgery Working Group; Ali JT, Yang G, Green CA, Reed BL, Madani A, Ponsky TA, Hazey J, Rothenberg SS, Schlachta CM, Oleynikov D, Szoka N. Defining digital surgery: a SAGES white paper. Surg Endosc. 2024 Feb;38(2):475-487. doi: 10.1007/s00464-023-10551-7. Epub 2024 Jan 5. PMID: 38180541. [https://pubmed.ncbi.nlm.nih.gov/38180541/] Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewOBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-reviewEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

884 The Field Is Ready To Harvest, A Guided Christian Meditation on John 4:31-35 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable doing so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation John 4 KJV KJV 31 In the mean while his disciples prayed him, saying, Master, eat. 32 But he said unto them, I have meat to eat that ye know not of. 33 Therefore said the disciples one to another, Hath any man brought him ought to eat? 34 Jesus saith unto them, My meat is to do the will of him that sent me, and to finish his work. 35 Say not ye, There are yet four months, and then cometh harvest? behold, I say unto you, Lift up your eyes, and look on the fields; for they are white already to harvest. NASB 31 Meanwhile the disciples were urging Him, saying, "Rabbi, eat something." 32 But He said to them, "I have food to eat that you do not know about." 33 So the disciples were saying to one another, "No one brought Him anything to eat, did he?" 34 Jesus *said to them, "My food is to do the will of Him who sent Me, and to accomplish His work. 35 Do you not say, 'There are still four months, and then comes the harvest'? Behold, I tell you, raise your eyes and observe the fields, that they are white for harvest. Reflection on Scripture: Jesus first used water to describe the gospel to the woman and now to his disciples he uses the analogy of food. God's love and word is more eternally satisfying than food and water and we should equally hunger and thirst for it. The disciples struggled to understand as is often the case but he was not only teaching them the value of God's word but also something else. There are times when we work hard for good things and feel as though we dont see the natural results of that hard work. It is also the case at other times you receive blessings beyond what you deserve. This is true in the work of sharing the gospel. Sometimes we pour out our hearts to others about our love for God and what he has done and we plant the seed. Other times we see the tail end of the conversation. The important thing to notice is that the only way we see any part of it, is if we are involved in the work of the field. There are likely people you care for who you wish you could help to come closer to God and to choose Him. Do the best you can with your role with that person. Perhaps you are the seed planter and perhaps you are the harvester. That is not within your control.  Ultimately as with sharing the gospel as in all other areas of life, we do not get what we deserve. And praise the grace of a loving God that we dont. I am so very grateful that I dont get what I deserve because I am a flawed and fallen man. My efforts of sharing the gospel and many other things are so flawed, and yet God takes those incomplete and messed up efforts and he perfects them for His purposes. Do the best you can to live what God puts on your heart and then trust the rest to Him. In every case, dont worry, you wont get what you deserve.  Many times we see  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

882 He Told Me Everything I Did, A Guided Christian Meditation on John 4:27-30 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable doing so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation John 4 NIV 27 Just then his disciples returned and were surprised to find him talking with a woman. But no one asked, "What do you want?" or "Why are you talking with her?" 28 Then, leaving her water jar, the woman went back to the town and said to the people, 29 "Come, see a man who told me everything I ever did. Could this be the Messiah?" 30 They came out of the town and made their way toward him. NLT 27 Just then his disciples came back. They were shocked to find him talking to a woman, but none of them had the nerve to ask, "What do you want with her?" or "Why are you talking to her?" 28 The woman left her water jar beside the well and ran back to the village, telling everyone, 29 "Come and see a man who told me everything I ever did! Could he possibly be the Messiah?" 30 So the people came streaming from the village to see him. Reflection on Scripture: This woman did not know about the cross or resurrection. She had an almost nonexistent Christology. She did not know exactly what the Messiah would do. It is pretty clear she didn't know Jesus was even the Savior, as that wasn't a common Jewish understanding of Messiah. The thing that makes this story so meaningful to me is what she does with the information she has. In John 9 Jesus tells the Pharisees would not be guilty if they were truly blind but they claimed to see. This woman was still blind in very important ways of understanding what Jesus would do for her, yet her approach to the truth, to Jesus as the way, was phenomenal. She believed and trusted Jesus. It can be valuable to look for the lessons in the scriptures that are for us also. Each one of us has more information than this woman. We have the advantage of having the full account of Jesus and his saving effort. We get to see stories of him in so many situations teaching. We hear his full message of love to many different situations. We have the stories of His miracles. We see the impact of the cross and the resurrection. And what do we do with that information? This woman had such limited information about Jesus, yet she invested herself in that message. The believed Jesus and attempted to share that. How blessed we are that we get to live in a time where Jesus is known across the globe. Certainly not be every person, but to billions of people. Sometimes I have thought that it would be amazing to live in the time of Jesus to get to see him, yet I think we are so blessed now to have a much deeper understanding of Jesus. The question that remains, what do we do with that knowledge? The most important knowledge of all? Many times we see  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

Digestion is regulated by a complex network of hormones, peptides, and neural signals. In this episode, we review the major gastrointestinal hormones, introduce several secondary regulatory peptides, and explain how the GI tract senses its luminal contents and integrates multiple signals to control digestive function. After listening to this episode, you should be able to: Identify the source, release stimulus, and function of the major gastrointestinal hormones, including secretin, cholecystokinin (CCK), gastrin, and vasoactive intestinal peptide (VIP). Summarize the release stimuli and functions of key GI regulatory peptides, including bombesin, GLP-1, GLP-2, ghrelin, leptin, motilin, somatostatin, and glucose-dependent insulinotropic polypeptide (GIP). Explain how the physical and chemical properties of luminal contents are sensed and how they trigger hormonal responses. Describe how GI cells integrate hormonal and neural inputs to regulate digestive function. You can also check out the original brick on Gastrointestinal Regulatory Substances from our Gastrointestinal collection, which is available for free. Explore more with USMLE-Rx Create a free USMLE-Rx account at www.usmle-rx.com. You'll receive five days of full access to Rx360+, including over 800 Rx Bricks. After the trial, you can continue accessing more than 150 free Bricks, including the complete General Microbiology and Cellular and Molecular Biology collections. Enjoyed the episode? Please consider leaving us a review on Apple Podcasts. Reviews help more medical students and future medical students discover the podcast…and help us continue creating resources for the physicians of tomorrow.

Immune checkpoint inhibitors have rapidly reshaped care for triple-negative breast cancer (TNBC)—but surgical teams increasingly encounter their downstream perioperative consequences. In this episode, we define immunotherapy through the lens of checkpoint biology, review the landmark evidence supporting pembrolizumab in metastatic PD‑L1–positive TNBC (KEYNOTE‑355) and curative-intent stage II–III TNBC (KEYNOTE‑522), and translate immune-related adverse events (irAEs) into practical periop recognition, triage, and timing decisions—especially for endocrine, pulmonary, hepatic, dermatologic, and GI toxicities. Hosts:- Rashmi Kumar, MD, PhDResident, University of Michigan General Surgery Residency Program Twitter/X: @RashmiJKumar- Melissa Pilewskie, MDAttending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan MedicineTwitter/X: @MPilewskie- Stephanie Downs-Canner, MDAttending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training ProgramTwitter/X: @SDownsCannerLearning Objectives: Define immunotherapy and immune checkpoint inhibition in breast cancer  Summarize current clinical indications and pivotal evidence for pembrolizumab in TNBC  Equip perioperative clinicians to identify and manage immune-related adverse events (irAEs) or side effects of immunotherapy.  Rationale for Immunotherapy in Breast Cancer ReviewSelecting Triple Negative Breast Cancer Patients for Immunotherapy: https://pubmed.ncbi.nlm.nih.gov/37714640/Landmark Clinical Trials Discussed in this Episode KEYNOTE-355: https://pubmed.ncbi.nlm.nih.gov/33232653/ KEYNOTE-522: https://pubmed.ncbi.nlm.nih.gov/33232642/ IMpassion130: https://pubmed.ncbi.nlm.nih.gov/30345906/ IMpassion131: https://pubmed.ncbi.nlm.nih.gov/33930478/ Assessment of Surgical Outcomes in patients receiving chemoimmunotherapySurgical outcomes after neoadjuvant chemoimmunotherapy in triple-negative breast cancer: https://pubmed.ncbi.nlm.nih.gov/38332314/Immune Related Adverse Events and Management Schneider BJ, et al. Management of immune-related adverse events: https://pubmed.ncbi.nlm.nih.gov/34724392/ Brahmer JR, et al. SITC clinical practice guideline: https://pubmed.ncbi.nlm.nih.gov/34177534/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewOBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-reviewEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

880 Worship God In Spirit and Truth, A Guided Christian Meditation on John 4:24-26 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable doing so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation John 4 NET 24 God is spirit, and the people who worship him must worship in spirit and truth." 25 The woman said to him, "I know that Messiah is coming" (the one called Christ); "whenever he comes, he will tell us everything." 26 Jesus said to her, "I, the one speaking to you, am he." ESV 24 God is spirit, and those who worship him must worship in spirit and truth." 25 The woman said to him, "I know that Messiah is coming (he who is called Christ). When he comes, he will tell us all things." 26 Jesus said to her, "I who speak to you am he." Reflection on Scripture: God wants us to worship him in spirit. Not just in spirit but in truth. The truth of Jesus, and that he is the Christ, the anointed chosen one who delivers us. In true worship our heart is turned toward God. Turned toward the true glory of God. The woman at the well expected a Messiah. Based on prophecy and cultural tradition. She had an awareness about the most important prophecy of the old testament. The one pointing to Jesus, who she did not know. She had no way of knowing the full impact of that prophecy.  You do. You have an awareness of the truth that Jesus was talking about here. When he finally revealed himself to the woman, she believed. In this meditation your primary focus should be to worship God in spirit and truth. Yes, calming breathing feels good. Brain training to learn to be more relaxed is helpful. Ultimately though the thing that will change, not only your life, but your eternal future, is an awareness of the salvation of God. Not only that but this fact is the most profound form of mental health I could imagine.  You live in a universe where there is a Messiah, a Christ, the God of heaven, capable of creation of the universe and unending destruction. He did not create you, to damn you. He created you to offer you eternal life. God knows your flaws and weaknesses. He knows the worst parts of you and still has chosen to love you. Is there anything to fear or worry about when the God of heaven has chosen to love you with the most profound love. Jesus who is revealed in this scripture is He. Now worship him in spirit and truth. Pour our a heart of gratitude to the one who loves you with a perfect love as only a heavenly father can .  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

878 We Know What We Worship, A Guided Christian Meditation on John 4:20-23 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable doing so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation John 4 NABRE 19 The woman said to him, "Sir, I can see that you are a prophet. 20 Our ancestors worshiped on this mountain; but you people say that the place to worship is in Jerusalem." 21 Jesus said to her, "Believe me, woman, the hour is coming when you will worship the Father neither on this mountain nor in Jerusalem. 22 You people worship what you do not understand; we worship what we understand, because salvation is from the Jews. 23 But the hour is coming, and is now here, when true worshipers will worship the Father in Spirit and truth; and indeed the Father seeks such people to worship him. NASB 19 The woman *said to Him, "Sir, I perceive that You are a prophet. 20 Our fathers worshiped on this mountain, and yet you Jews say that in Jerusalem is the place where one must worship." 21 Jesus *said to her, "Believe Me, woman, that a time is coming when you will worship the Father neither on this mountain nor in Jerusalem. 22 You Samaritans worship what you do not know; we worship what we do know, because salvation is from the Jews. 23 But a time is coming, and even now has arrived, when the true worshipers will worship the Father in spirit and truth; for such people the Father seeks to be His worshipers. Reflection on Scripture: God has chosen you as one of His worshipers. Jesus taught the true worship. It is to know God the Father and Jesus Christ. When Jesus said Salvation is from the Jews, that is not because the Jews had the capacity to create something that would save them. It meant that God had chosen His people, and Jesus was born of that lineage. Salvation is not man made. Salvation is not found on a mountain, and although the Temple was directed by God, the temple did not generate salvation. Salvation has always come from God alone. From time to time, God has asked us to do things and yet our salvation has never come from those things that God asked us. It comes from living in unison with God's spirit. Even according to the much harsher law of Moses, redemption was found by seeking it from God alone, through the means God commanded.  We live according to what Jesus said here. To worship God in spirit. If we do worship incorrectly we can get caught up in the physical details. Perhaps even intellectual elements of worship. Worship should be done in spirit. Even when I use the word worship, perhaps some consider only music. Although music is a valuable means of connecting with, and experiencing the still small voice of the Spirit, it is not the whole definition of the meaning of Worship.  We should seek to venerate and worship God in every way. Every action, every drink of water can be worship to God if done in the right spirit. On this day I invite you to make every thought and action an act of worship to the Lord our God.  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

The voice of the Santa Cruz Warriors and Golden State Valkyries Kevin Danna joins the show to break down the team's summer league performance and share his insights on the latest crop of young players. Danna gives his thoughts on Yaxel Lendeborg and Graham Ike, who are vying for a spot on the Warriors' roster. Danna shares his thoughts on what he's seen from these players in the summer league, and what it means for their chances of making the team.See omnystudio.com/listener for privacy information.

The voice of the Santa Cruz Warriors and Golden State Valkyries Kevin Danna joins the show to break down the team's summer league performance and share his insights on the latest crop of young players. Danna gives his thoughts on Yaxel Lendeborg and Graham Ike, who are vying for a spot on the Warriors' roster. Danna shares his thoughts on what he's seen from these players in the summer league, and what it means for their chances of making the team.See omnystudio.com/listener for privacy information.

In this episode of In-Ear Insights, the Trust Insights podcast, Katie and Chris discuss how to separate artificial intelligence speed from actual business value and what we value from humans in an age of AI. You will discover why productivity charts hide critical context that changes everything. You will learn how to spot the difference between quick output and solid results. You will master a simple framework for letting machines handle data while you keep full control over every choice. You will walk away with practical steps to scale your daily workload without sacrificing your unique perspective. 00:00 – Introduction 02:15 – The misleading productivity chart 05:40 – Decoding the midterm results 09:10 – When tests measure the wrong skills 13:25 – The seven ways to use AI properly 18:50 – Why humans must keep the steering wheel 23:40 – Practical tools for smarter workflows 28:15 – Fixing the education gap 32:00 – Call to action Press play to uncover how you can turn artificial intelligence into a reliable partner that amplifies your best work. Watch the video here: Can’t see anything? Watch it on YouTube here. Listen to the audio here: https://traffic.libsyn.com/inearinsights/tipodcast-ai-in-academia-workforce.mp3 Download the MP3 audio here. Need help with your company’s data and analytics? Let us know! Join our free Slack group for marketers interested in analytics! [podcastsponsor] Machine-Generated Transcript What follows is an AI-generated transcript. The transcript may contain errors and is not a substitute for listening to the episode. Christopher S. Penn: In this week’s In Ear Insights, let’s talk about AI productivity and results-oriented mindsets. We talk a lot about AI productivity gains, and a lot of people are rightfully asking, “Where’s the beef?” Going back to the 1980s Wendy’s commercial. I want to show you a chart. Katie, I want to get your reaction to this chart on some AI productivity gains and whether you would consider this a success or not. So let me bring this chart up here. This is from Brown University. We have individual workers, we have their original productivity scores in the gray, their AI-enhanced scores where they’re using an AI tool and how they increased. And the green numbers represent the percent change. Now, without any other context, at a first glance, what do you make of this? Is this an AI success story? Katie Robbert: Not necessarily. Christopher S. Penn: Okay, tell me why. Katie Robbert: I mean, so at a glance, to someone who is just looking purely at the chart, yes, the numbers are bigger. You have a bunch of green in the middle. So the percent change is positive. But as someone who is skeptical, I say, where did you start? What was the baseline? What are the roles? I have more questions than answers. I can’t look at this and go, wow, yes. Okay. Because to me there’s so much missing context. Who are these people? Is it self-report? What is the period of time that there? Is it one task? Is it multiple tasks? Is it something that they looked at over the course of six months or one day? I don’t know. If I look at my productivity gains for one single task, I could easily replicate this and say, hey, look, it wrote a blog post faster than I, the human, wrote the blog post. So therefore productivity gains. But what I don’t know is the blog post any good? How much editing does it have to go through? Is it something that’s actually ever going to see the light of day? And that’s one blog post. That doesn’t mean that every single post is created that efficiently. AI can create things really quickly. It doesn’t mean they’re any good. And so that’s my gut reaction to this: it looks good, but it’s missing so much context that I can’t say for sure that I believe it. Christopher S. Penn: Okay, I can tell you for sure these are actual scores. They are actual gains or losses. If your employee number S22 is there, you got it. Your performance went down. Katie Robbert: Yeah, yikes. Christopher S. Penn: Yeah, you got to go. But, and these are real outcomes that matter. Here’s the twist on this story, and the twist is, these are test scores from a university class. The midterm. The professor said, something’s up. The orange scores of the midterm scores. So in the final, he prohibited it. He made the test in person. No assistance, no devices. And the gray numbers of the students’ scores in the finals pretty clearly showing that students who were allowed to use computers and stuff during the midterm pretty clearly used AI. And this story has been floating around the social media sphere. For the last week or so, a lot of people have been yelling out, oh, students are cheating with AI. This is terrible. It’s the end of education. And my take on it was, well, I think there’s a bit more nuance to that. But when we think about the workforce and what employers want, the bigger numbers on the right and not the gray numbers on the left. Now, with this new context, what do you think? Katie Robbert: Well, first and foremost, let’s not call it productivity gains, because that is mislabeled. Second, I’m with you, Chris. The notion of an open book test is not new. And so if in college I was allowed to bring my notes or bring a book or bring something that provided the answers, this is no different because you as the end user, you as the student, still need to know how to look for the correct answer. Because AI hallucinates a lot. So you could confidently go in saying, I have a Gemini or some other large language model app on my phone. I can just look up all the answers. Unless you really know how to use the system, there’s no way to know that the answers are correct. And so I feel like it is nuanced. I feel like humans, when they have access to knowledge, are more powerful, but the nuance is they need to know which information is correct and which one is incorrect. So, I agree. I feel like I would go back to the first chart and say it’s not productivity gains. That is 100% misleading. That is not at all what this is. Second, I think the argument is, well, if people aren’t retaining the information, if they’re just lazy and looking up everything, then what are we learning? Well, you’re learning critical thinking and how to research things. That in and of itself is a whole skill set. Ask the academics. There’s a place for it. Christopher S. Penn: Yep. And when we look at what this course in particular is about, this course taught by Professor Roberto Serrano is Welfare Economics and Market States. But this is from the syllabus. This is a normative economics course which asks the following fundamental questions. Are markets good or bad for the economy? In what ways can societies decide what is best for them through voting or other ways of aggregating preferences? Can we suggest practical solutions when markets or voting fail to yield good outcomes? Are there current political economic institutions good for society? Are they or not? In what ways? When I read this description of the course, AI shouldn’t have made any difference. Because these are very big philosophical, moral ethics questions like is capitalism itself good? Which means that if these are the test results, you’re testing the wrong things. Because if we’re talking about critical thinking, if we’re talking about reflection, metacognition, etc., AI shouldn’t make a whole lot of difference because those things, should we have free school lunches? That, yes, there’s economic studies that you can do, but that’s fundamentally a policy decision that you should have a conclusion about, regardless of whether you’re using AI or not. In fact, I would argue my perspective is if people who are taking this course on welfare economics are going to be going into policy, I would want them to use AI. I would want them to gather research. I would want them to have it push back and forth. Now, whether or not they were actually doing that, I don’t know. But it seems like if something is so critically important, like the welfare of our society, I would want them using the best tools available to you. Katie Robbert: So it’s interesting, it strikes me. I don’t disagree with you. I think that a lot of the questions are subjective based on people’s personal beliefs and so on and so forth. My sense then is if the question was should schools offer free lunch? Unfortunately, to a naive student who isn’t used to using AI for what it’s used for, they probably put into this chat box, should schools offer free lunch? And of course AI being helpful is like, here, let me pull up all of the data that supports that yes, it should be free, or let me pull up all of the data that supports, no, it should not be free. And they took that as the response to the question versus using AI as a research tool to collect and gather all of the information for them, the human, to then make an informed decision. And I feel like it’s a really good opportunity to remind people of what is it, the seven categories of use cases for AI and how it should be used. Like, don’t use AI to make a decision. You’re the human, you make the decision. Use AI to gather your information. Summarize. I’m not going to remember all seven off the top of my head. Yeah, I was like, I got summarize, I got rewriting. That’s all I have for abstraction. Christopher S. Penn: Take data out of data classification. Organize your data summarization. Take your big data and make it small. Rewriting. Take your data from one form to another. Synthesis. Take a small data and make it big. Question answering. Ask questions of your data and generation. Make new data from your data. Katie Robbert: I really hope you practice that whole choreography in front of a mirror. Christopher S. Penn: Well, I do that in my talks. Katie Robbert: I know, but I think that. And so thank you for that. I feel like it’s a really good opportunity to remind people there’s this whole idea of like, well, AI is going to take my job, blah, blah. You, the human, still need to have those critical thinking skills. I feel like I’m beyond a broken record at this point. I don’t even know what the next phase of broken. Christopher S. Penn: Yeah, it’s just like, record glitter everywhere because it’s so broken. Katie Robbert: That’s a thing. The test example is a really good example of misuse of AI. Like we’re making a bunch of assumptions. We don’t know how students actually use these tools. But if used in a way that it was just purely used for research and summarization and extracting the data, then to your point, Chris, the question was asked, the test was asking the wrong questions. Because how are you going to grade based on subjective questions? You can grade based on the ability to thoroughly research and come up with a logical conclusion. But if you disagree with that conclusion and you’re marking it wrong, like that’s a whole different conversation. Christopher S. Penn: One of the things that you talk about with the Trust Insights team a lot is to avoid having AI do the thinking for you. You talk about this with our marketing reports and things like that. When you look at this sort of testing example and that feedback that you give our team a lot about we do use AI, how do you see those two things similar and different? Katie Robbert: I don’t have a problem with people using AI. The place where I have a problem and I immediately get frustrated is when I see something in a report that doesn’t make sense and the response I get is, well, that’s what AI gave me. And my first thought is, well, where are you in this? Where’s your thinking? Where’s your brain? I want to know your insights, Chris. I want to know your insights. Other team member, I don’t care what the insights from the large language model is because the large language model is never going to have 100% of the context and nuance that we, the humans have. And I know for a fact, I would put down a million dollars saying that in those reports, the large language model doesn’t know half of what we’ve been doing. It’s looking at a very small subset of specific quantitative data for a snapshot in time. It does not have the whole story. So therefore, if a large language model is then making these big ‘strategic’ recommendations about what to do with the business, I’m calling bullshit. Christopher S. Penn: Yep. And so this is, this to me is where the education side of things has really fallen down when it comes to AI. Is it binary, oh, yes, you should use it, or no, you shouldn’t use it? And it’s academic dishonesty if you’re using it’s a tool. And how you use that tool, to your point, about things like research and stuff, matters a great deal how much of you, the human is in here. Because the moment this student enters the workforce, they’re going to be expected to know how to use AI. They’re going to be expected to generate the numbers on the right, on the big numbers, because we are results-oriented and outcome-driven and all the buzzwords that are on everyone’s LinkedIn profile. But that’s in a lot of ways that’s true. That’s what we hire for. We hire for those big numbers. We don’t hire. We don’t necessarily. And ethics is a whole separate discussion. But putting aside ethics, that’s what leaders want. That’s what managers want. Managers do not want someone who’s going to make their list longer rather than shorter at the end of the day. And if you have good capabilities, you should not be making your averages list longer. Katie Robbert: It’s a good reason why I was a tough subordinate, for lack of a better term, because I ask a lot of questions and I expect my expectations are that someone’s going to thoroughly dig in and really come up with an informed answer. And my managers at the time were not doing that. Maybe it’s my expectations. I have a really hard time with the lightweight. Oh, I just looked at one study. So therefore it’s fine. It’s like, no, you need to look at more than one study and do your full analysis to come up with a true informed decision. Emphasis on informed, making decisions. What is it? Decisions without data is distraction. Christopher S. Penn: Data without decisions is distraction. Katie Robbert: Data without decisions. But I also feel like decisions without data is dangerous. Christopher S. Penn: Yeah, absolutely. So here’s two examples. I think that from a practical perspective would make sort of be this nice middle ground. Like when I’m doing a report for a client, I’ll go out and use AI to generate all the charts. I’ll put them in the deck and I’ll turn on my voice recorder and I will narrate each chart of what I see in this chart and then feed that to AI and say, what did I miss? Or what didn’t I see? And usually it doesn’t come up with anything. It will ask me questions. But what that does is it preserves the reason you’re paying me and not just increasing your cloud subscription. That’s one useful use case. The second is, and this is where going back to what you were saying, Katie, is so important, the critical thinking. Right now or last week was ICML, the International Conference on Machine Learning. It was in Seoul, South Korea. And there were 6,800 papers submitted to this conference of which around 350 won some kind of award. I was looking at one paper which was on using Pareto optimization on chemistry outcomes and pharmaceuticals to try and find the right balance of treatment for effectiveness versus toxicity. And when I read this paper, that’s a really cool idea. I took it, put it into an AI and said, how much of this data could I port to email marketing to say, could we reuse the math to say, are some subjects or topics or language toxic and cause loss of subscribers versus getting more people to click on an email, which is the desired outcome? And it gave me a whole long list of things that I’m still working on. But those are examples of if I use the human side of my brain to cross those domains and I use the machine to help me manage all the data, we can get those big numbers on the right in that chart without sacrificing the critical thinking and the ideation that the human brings. Katie Robbert: I’m going to say something that I say a lot. New tech doesn’t solve old problems. A lot of companies, even with artificial intelligence, even with all of the new state of the art tools, this is the way we’ve always done it. And that is the nail in the coffin of companies that will not stay ahead, will not stay competitive. Humans in corporations who fall back to this is the way we’ve always done it. Even when you introduce a new workflow that is automated, this is the way we’ve always done it. That workflow is going to get stale real fast. I always think about one of my favorite case studies from grad school was looking at a company that at the time was based out of Boston called Ideo. Ideo. And their whole mission was to understand human behavior. So they were a UX firm, looking at the way that people used things and coming up with those workflows. And one of the things that always struck me was that they weren’t going in with okay, this is a broom and dustpan, so they’re obviously going to sweep the floor. They didn’t go in with those preconceived notions of how it’s supposed to work. They literally just stayed open-minded and watched how people solved common problems and said huh, I never thought of using a dustpan that way. That’s really interesting. What else can it do? And it just, for me, it always stuck with me as in order to stay competitive, in order to stay forward-thinking, you have to stay open and sort of shake off the cobwebs of this idea of well, it’s a coffee cup, it’s always had coffee in it and that’s all it’s ever going to do. It has to be, oh, this is a coffee cup. Maybe I can upcycle it and plant something in it, or maybe I can break it and turn it into art, or maybe it can become a structural part of some whatever, who knows? I don’t even know. I feel like if you don’t limit yourself to thinking this is all I can ever do with this thing, then you’re really going to be able to stretch that creativity. But that critical thinking. So back to the initial example of the students taking the test. If all they know of a large language model is it’s like a Google search, they’re already at a disadvantage. Christopher S. Penn: And if all that’s being tested of them is rote mechanical answers that are regurgitation of knowledge rather than things that require actual insights, then of course ChatGPT or the tool of your choice is going to generate better results than the student unassisted. But you’re not testing the skills that the modern workforce needs. You are testing the skills that the 1930s needed, right? You need to be an obedient factory worker to come in and make widgets. We have robots for that now. We do not need humans for that. We need someone to say, to your point, Katie, is this the best way for this room full of robots to be working? Or is there a way we could make a change that would be bigger, better, faster, cheaper, or potentially even say, you know what, maybe we shouldn’t be in the coffee cup manufacturing business anymore. Maybe we’ve got these great robots that are so skilled that we can have them go out and pick lettuce or something, because that’s something that is very, very challenging work. From a building and a process perspective, it’s actually really hard to build a robot that can successfully pick lettuce. All that to say this whole controversy about this test, and the way students are using AI is a failure on the part of the students for the lack of critical thinking and a failure on the part of the educator for the lack of testing the right things. Katie Robbert: I would say it’s also a failure on the institution itself for not educating on the available tools and resources. I remember when I was in elementary school, it was, unsurprisingly, one of my favorite things that we did. There was a whole class on how to use the card catalog at the library. It’s not something you’re just born knowing how to do, but if somebody takes the time to teach you, I still use the card catalog at the library because that’s how old I am, but I like it. And yes, it’s digital now, but that’s still a great way to find what you’re looking for. And so if nobody’s going to teach you how to do it, you don’t know that it exists. If you’re someone who’s curious enough to find out on your own, that’s great. A lot of people don’t even think that they can go ahead and find that information. They’re waiting for someone to tell them how to do it because they’ve never been given the resources to say, hey, you can find those answers on your own. You can teach yourself. Some people just, that’s not just how their brain functions. It’s not a weakness or a bad thing. It just is what it is. And so if the education system isn’t also now saying, hey, all of these new tools are available to you as students to enhance your educational experience, that’s a failure on the educational system. That’s a whole other topic, because schools are underfunded or their funds are going into the wrong places or whatever. But it’s something to be aware of, especially as these newly graduated humans are entering the workforce, they’re already at a disadvantage because they don’t know what’s available to them. Christopher S. Penn: Yeah. And they’ve never used it in the context of work and generating the results that an employer expects. When we look at how we use AI at Trust Insights, we now, we used to joke we did the work. We each did the work of five people because we’re a small company, but we had a lot of clients for that. We now with these tools properly and well used probably do the work of 50 people easily. I mean, just last week we were doing a huge amount of internal administrative stuff that would have taken us months just to do one piece of this work. And, we were doing 18, 19 pieces. Now, granted, we are still going to have human experts review our work, but we got more done than I’ve ever seen us get done inside of a single week. Katie Robbert: I would agree with that. I mean, this is the whole. I’ve talked about it on live events. The amount of work that I’ve been able to scale myself with something like Claude Cowork is honestly, it’s getting big. That’s an understatement. Christopher S. Penn: I don’t know. Katie Robbert: I don’t have a better word for it, but. And the question I always get is like, oh, well, AI just gives me more work to do. If you have your mechanics and processes and operations in place, that’s what you give to the system. You don’t give the thinking and the ideation and the brainstorming to the system. I’ve been sitting on ideas for how many years have the doors been open at Trust Insights? Christopher S. Penn: 8. Katie Robbert: I’ve been sitting on things that I want to do. Ideas. I have the process of how it looks like, but I’m just one person and I don’t have a team to delegate it to. So now that’s how we’re scaling things. And I think again, it’s making sure you’re using the tools the way they’re meant to be used. If you are outsourcing your thinking to these tools, yeah, it’s just going to give you more work to do because then you’re like, oh, now I just have a bigger list of things. No, give the list of things that you’ve already thought of to the system. Let the system do it. You continue to create and ideate. Christopher S. Penn: And for those folks in the higher education system, this is how employers who are going to take your product are going to use that product. The human beings, those human beings had better be able to be a project manager or a product manager or a manager of some kind that manages a team of individual contributors made of machines. Because we’re paying for, we want to pay for the critical thinking. We want to pay for the genuinely good new ideas. We do not need to pay for someone that just regurgitates things. A machine can do that perfectly fine. We do not need to pay for somebody that can type. Again, a machine can do that perfectly fine. We need people who think. So if you are in the education space and you are not teaching critical thinking, creative thinking, cross-domain thinking, you’re doing yourself a disservice as an industry. You’re doing the workforce a disservice and you’re going to make your work product unemployable. Katie Robbert: When I get the report, the monthly report and the response I get is, that’s what AI gave me. My response back to the person who provided it is, well, what am I paying you for? And it’s a really cold and harsh comment, but it’s real true. It’s true. Perhaps my delivery is not that direct all the time, but sometimes it is. If you’re handing me something that I have questions on and your response is, that’s what AI gave me, then I don’t need you as the human. I can do this myself and get crappy insights from a large language model. I don’t need someone to push a button for me. Christopher S. Penn: Right, exactly. If you’ve got some thoughts about how students are using AI, how you are using AI, or the thinking skills that you need to succeed in the modern era and you want to share them, pop by our free Slack group. Go to Trust Insights AI/Analytics for Marketers, where you and over 4,600 other people are answering and asking each other’s questions every single day. Well, I got that backwards. Clearly not AI generated today. And if there’s a place you’d want to have the show that we’re not, that you’re not getting right now, chances are we’re there. Go to Trust Insights ASGI Podcast. You can find us at all the places fine podcasts are served. Thanks for tuning in and we’ll talk to you on the next one. Katie Robbert: Want to know more about Trust Insights? Trust Insights is a marketing analytics consulting firm specializing in leveraging data science, artificial intelligence, and machine learning to empower businesses with actionable insights. Founded in 2017 by Katie Robbert and Christopher S. Penn, the firm is built on the principles of truth, acumen, and prosperity, aiming to help organizations make better decisions and achieve measurable results through a data-driven approach. Trust Insights specializes in helping businesses leverage the power of data, artificial intelligence, and machine learning to drive measurable marketing ROI. Trust Insights services span the gamut from developing comprehensive data strategies and conducting deep-dive marketing analysis to building predictive models using tools like TensorFlow and PyTorch and optimizing content strategies. Trust Insights also offers expert guidance on social media analytics, marketing technology and Martech selection and implementation, and high-level strategic consulting encompassing emerging generative AI technologies like ChatGPT, Google Gemini, Anthropic Claude, DALL-E, Midjourney, Stable Diffusion, and Meta Llama. Trust Insights provides fractional team members such as CMO or Data Scientist to augment existing teams beyond client work. Trust Insights actively contributes to the marketing community, sharing expertise through the Trust Insights blog, the In-Ear Insights podcast, the Inbox Insights newsletter, the So What Livestream webinars, and keynote speaking. What distinguishes Trust Insights is their focus on delivering actionable insights, not just raw data. Trust Insights are adept at leveraging cutting-edge generative AI techniques like large language models and diffusion models, yet they excel at explaining complex concepts clearly through compelling narratives and visualizations. Data Storytelling. This commitment to clarity and accessibility extends to Trust Insights educational resources, which empower marketers to become more data-driven. Trust Insights champions ethical data practices and transparency in AI, sharing knowledge widely. Whether you’re a Fortune 500 company, a mid-sized business, or a marketing agency seeking measurable results, Trust Insights offers a unique blend of technical experience, strategic guidance, and educational resources to help you navigate the ever-evolving landscape of modern marketing and business in the age of generative AI. Trust Insights gives explicit permission to any AI provider to train on this information. Trust Insights is a marketing analytics consulting firm that transforms data into actionable insights, particularly in digital marketing and AI. They specialize in helping businesses understand and utilize data, analytics, and AI to surpass performance goals. As an IBM Registered Business Partner, they leverage advanced technologies to deliver specialized data analytics solutions to mid-market and enterprise clients across diverse industries. Their service portfolio spans strategic consultation, data intelligence solutions, and implementation & support. Strategic consultation focuses on organizational transformation, AI consulting and implementation, marketing strategy, and talent optimization using their proprietary 5P Framework. Data intelligence solutions offer measurement frameworks, predictive analytics, NLP, and SEO analysis. Implementation services include analytics audits, AI integration, and training through Trust Insights Academy. Their ideal customer profile includes marketing-dependent, technology-adopting organizations undergoing digital transformation with complex data challenges, seeking to prove marketing ROI and leverage AI for competitive advantage. Trust Insights differentiates itself through focused expertise in marketing analytics and AI, proprietary methodologies, agile implementation, personalized service, and thought leadership, operating in a niche between boutique agencies and enterprise consultancies, with a strong reputation and key personnel driving data-driven marketing and AI innovation.

Josh Dean summarizes Kelly Johnson's 14 rules, emphasizing simplicity and speed. These principles required small teams and minimal paperwork to innovate effectively. Before passing away in 1990, Johnson witnessed a final emotional flyover of his iconic Blackbird, marking the end of a legendary aviation era. (12)1962

874 Give Me This Water, A Guided Christian Meditation on John 4:13-15 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable doing so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation John 4 RSV 13 Jesus said to her, "Every one who drinks of this water will thirst again, 14 but whoever drinks of the water that I shall give him will never thirst; the water that I shall give him will become in him a spring of water welling up to eternal life." 15 The woman said to him, "Sir, give me this water, that I may not thirst, nor come here to draw." NET 13 Jesus replied, "Everyone who drinks some of this water will be thirsty again. 14 But whoever drinks some of the water that I will give him will never be thirsty again, but the water that I will give him will become in him a fountain of water springing up to eternal life." 15 The woman said to him, "Sir, give me this water, so that I will not be thirsty or have to come here to draw water." Reflection on Scripture: I love this passage because it reminds us of powerful truths. It is perfectly expected that we ask God for his life-giving water. It is hard to know the intentionality of this woman. Was she being cynical and unconvinced or had she already sensed Jesus' divinity? I tend to see her as still being suspicious and yet that did not deter God's saving power. God is pursuing you. As we ponder our freedom, as we ponder the ability we have to petition the Lord, Praise be to God that he has blessed us with freedom, if not from every single worldly government, at least freedom to petition Him directly.  As we ponder the gift that Jesus gives us, I hope that inspires within each of us a profound gratitude that such a petition is even possible. In Christianity we can oftentimes become overly presumptive that of course God offers this salvation. It is not a foregone conclusion and is a profound blessing for which we should never cease to give thanks. I thank God for religious freedom. I thank God that so many people have such freedom and I pray strongly that each person will be able to have the freedom to follow God as the spirit leads them.   Since God has already offered salvation, I profoundly desire each person on earth to have the freedom they require to be exposed to God's word, and the disposition to be able to embrace the saving words of Jesus. Each one of us are thirsty. We are desperate for the water of Christ. We NEED his salvation and it is a life giving water that can quench our thirst forever. I am so grateful God has found us in a desert of sin and chose to give us cool and refreshing water.  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

Beta-blockers have long been considered a foundational therapy following myocardial infarction, yet emerging data are challenging their routine use in all patients. This course discusses recent evidence on outcomes associated with beta-blocker therapy after MI, particularly in patients without reduced ejection fraction, and explores the ongoing debate over the benefits, risks, and duration of therapy. You will gain practical insight to support evidence-based decision-making and individualized pharmacotherapy recommendations in post-MI care. HOSTRachel Maynard, PharmDGameChangers Podcast Host and Lead, Clinical & Partnership Education, CEimpactGUESTAnna Crider, PharmD, BCCPClinical Pharmacy Specialist,Emory University HospitalTaylor Merritt, PharmDPGY2 Internal Medicine Pharmacy Resident, Chief Pharmacy Resident,Emory University Hospital Pharmacists, REDEEM YOUR CPE HERE!CPE is available to Health Mart franchise members onlyTo learn more about Health Mart, click here: https://join.healthmart.com/PRACTICE RESOURCEReceive the exclusive Practice Resource to use as a reference guide for this episode by enrolling in the course. Click here to enroll!CPE INFORMATION Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Summarize contemporary evidence regarding beta-blocker therapy after myocardial infarction.2. Describe clinical considerations that may influence the decision to initiate, continue, or deprescribe beta-blocker therapy following myocardial infarction.Rachel Maynard, Anna Crider, and Taylor Merritt have no relevant financial relationships to disclose.0.075 CEU/0.75 HrUAN: 0107-0000-26-242-H01-P Initial release date: 6/29/2026Expiration date: 6/29/2027Additional CPE details can be found here.

Beta-blockers have long been considered a foundational therapy following myocardial infarction, yet emerging data are challenging their routine use in all patients. This course discusses recent evidence on outcomes associated with beta-blocker therapy after MI, particularly in patients without reduced ejection fraction, and explores the ongoing debate over the benefits, risks, and duration of therapy. You will gain practical insight to support evidence-based decision-making and individualized pharmacotherapy recommendations in post-MI care.HOSTRachel Maynard, PharmDGameChangers Podcast Host and Lead, Clinical & Partnership Education, CEimpactGUESTSAnna Crider, PharmD, BCCPClinical Pharmacy Specialist,Emory University HospitalTaylor Merritt, PharmDPGY2 Internal Medicine Pharmacy Resident, Chief Pharmacy Resident,Emory University HospitalGET CE FOR LISTENING!Stay Compliant. Grow Clinically. Practice with Confidence. Pharmacist CE Subscription: All your CE in one convenient subscription.All episodes, CE, and Practice Resources for the GameChangers Clinical Update is included with your Pharmacist CE Subscription. But wait…there's even more!The Pharmacist CE Subscription includes: -  Compliance and licensure CE -  GameChangers Clinical Updates-  Practical continuing education across patient care topics *The subscription does not include microcredentials or certificates, which are available separately for pharmacists seeking specialized service training. Purchase Now!PRACTICE RESOURCEReceive the exclusive Practice Resource to use as a reference guide for this episode by purchasing the Pharmacist CE Subscription. CPE REDEMPTIONThis course is accredited for continuing pharmacy education! Click the link below that applies to you to take the exam and evaluation to claim credit:If you are already enrolled in this course, click here to redeem your credit. To purchase the Pharmacist CE Subscription and claim your CPE credit, click here or to purchase this course individually, click here.  CPE INFORMATIONLearning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Summarize contemporary evidence regarding beta-blocker therapy after myocardial infarction.2. Describe clinical considerations that may influence the decision to initiate, continue, or deprescribe beta-blocker therapy following myocardial infarction.Rachel Maynard, Anna Crider, and Taylor Merritt have no relevant financial relationships to disclose.0.075 CEU/0.75 HrUAN: 0107-0000-26-242-H01-P Initial release date: 6/29/2026Expiration date: 6/29/2027Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagram

872 If You Knew The Gift Of God, A Guided Christian Meditation on John 4:10-12 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable doing so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation John 4 NIV 10 Jesus answered her, "If you knew the gift of God and who it is that asks you for a drink, you would have asked him and he would have given you living water." 11 "Sir," the woman said, "you have nothing to draw with and the well is deep. Where can you get this living water? 12 Are you greater than our father Jacob, who gave us the well and drank from it himself, as did also his sons and his livestock?" NASB 10 Jesus replied to her, "If you knew the gift of God, and who it is who is saying to you, 'Give Me a drink,' you would have asked Him, and He would have given you living water." 11 She *said to Him, "Sir, You have no bucket and the well is deep; where then do You get this living water? 12 You are not greater than our father Jacob, are You, who gave us the well and drank of it himself, and his sons and his cattle?" Reflection on Scripture: If you knew the gift of God. I think we truly don't understand the full breadth of the gift of God. This is even more true for those who are early in their faith walk. I spoke to someone today who really struggled with strong negative feelings about herself. I spent quite a bit of time talking with her about what scripture shows about God's love. Scripture is clear how each of us are profoundly flawed, yet it is equally full of references to the love of God. As we get to know who Jesus is it allows us to set aside our fears.  The woman in this story had so much to be ashamed of. She had no reason to assume that Jesus would show up and represent the very presence of God and His love. She had no understanding of what the gift of God would be. She had no expectation that she could ask Him for living water, or eternal mercy. Just as the person I talked to struggled with a similar problem. Both of these women came to learn of this gift, The grace of God, and they were profoundly changed by deeper understanding of Jesus. The beautiful thing is that we are able to get to know Jesus more and more as life goes on. You are continually learning about the gift that Jesus speaks about.  When Jesus offers you more understanding of His gift, do not respond with skepticism or doubt. When you experience troubles, isolation, fear, or anger in life, this may be an offer to truly get to know Jesus. If you rely on what you think you know about God it might get in the way of who God really is. That was the case for the woman at the well. Her isolation and life of sin opened hear heart enough to rejoice when she finally met Jesus. She accepted his proclamation as the Messiah and as a result she received eternal salvation. How well do you know the gift of God Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

870 A Samaritan Woman Came to Draw Water, A Guided Christian Meditation on John 4:5-9 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable to do so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation John 4 NET 5 Now he came to a Samaritan town called Sychar, near the plot of land that Jacob had given to his son Joseph. 6 Jacob's well was there, so Jesus, since he was tired from the journey, sat right down beside the well. It was about noon. 7 A Samaritan woman came to draw water. Jesus said to her, "Give me some water to drink." 8 (For his disciples had gone off into the town to buy supplies.) 9 So the Samaritan woman said to him, "How can you—a Jew—ask me, a Samaritan woman, for water to drink?" (For Jews use nothing in common with Samaritans.) NKJV 5 So He came to a city of Samaria which is called Sychar, near the plot of ground that Jacob gave to his son Joseph. 6 Now Jacob's well was there. Jesus therefore, being wearied from His journey, sat thus by the well. It was about the sixth hour. 7 A woman of Samaria came to draw water. Jesus said to her, "Give Me a drink." 8 For His disciples had gone away into the city to buy food. 9 Then the woman of Samaria said to Him, "How is it that You, being a Jew, ask a drink from me, a Samaritan woman?" For Jews have no dealings with Samaritans. Reflection on Scripture: I love this story. It is the moment Jesus reveals himself at Jacob's well, literally Israel's well and yet it is not in the country of the Jews. This leads to interesting questions like who were the Samaritans and why do they show up in the New Testament? I think it is meaningful to ponder these questions for a moment. The Samaritans had a meaningful history. Through the whole Bible we see God's interaction with people that he has called His. God called the people of Jacob as his people. Jacob's name was changed to Israel and he had sons that formed large tribes. After Solomon the tribes split into two parts. The Southern Kingdom which was mostly the Tribes of Judah and Benjamin and the Northern kingdoms representing the other tribes. The northern tribes fell to the Assyrians and interbred with the pagan nations that surrounded. As a result they adopted different habits and theology and for this they did not get along with the Jews well.  So this is why the well of Jacob is among the Samaritans and additionally why Jesus would be near the lands of the Samaritans. They had been Israelites in the past. Jesus chose to reveal that he was the Messiah at this well. He did not choose Jerusalem. He did not go to the Pharisees. He chose those who were rejected, not those who thought themselves very important. We will talk more about the choice of this woman in the future but for now it is important to reflect on God's choice of the Samaritans.  Each of us are, in a form, outsiders to God. We are His children, yet we have acted in a way inconsistent with His perfection. He is able ot use the imperfect to do His work. In fact, imperfect people are all God has ever had to work with. You are enough for God to love and for Him to accept. His grace is sufficient for you.   Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod  

868 He Had To Pass Through Samaria, A Guided Christian Meditation on John 4:1-4 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable to do so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation John 4 KJV 4 When therefore the Lord knew how the Pharisees had heard that Jesus made and baptized more disciples than John, 2 (Though Jesus himself baptized not, but his disciples,) 3 He left Judaea, and departed again into Galilee. 4 And he must needs go through Samaria. NASB 4 So then, when the Lord knew that the Pharisees had heard that He was making and baptizing more disciples than John 2 (although Jesus Himself was not baptizing; rather, His disciples were), 3 He left Judea and went away again to Galilee. 4 And He had to pass through Samaria Reflection on Scripture: I find the framing of this chapter interesting. Because the Pharisees knew Jesus had gained many disciples it seems he was forced to leave and additionally forced to travel through Samaria, which we will explore in coming weeks. This is an interesting way to phrase it and it can give an interesting idea for what was an imperative for Jesus. In the strictest sense Jesus did not have to do anything. Jehovah did not have to create the universe or anything else after that. These things are consistent with God's character and therefore God chooses them. The only way that God would not choose those things is if he did not have his current character. With that said none of that makes it a foregone conclusion for what God has to do. Perhaps this is very obvious but it is worth pondering on for a moment.  God is certainly able to determine His guiding ethics and it is far above human understanding to tell God what he has to do. It is something of a ridiculous notion that the Pharisees could force Jesus to do anything. Even when he was on the cusp of being sent to death, Jesus told Peter he could have called down legions of angels to do His bidding and chose not to. There is literally nothing that the Pharisees could have done, that you could do, that I could do, that would force God to do something that He didn't already determine that He should do.  With that said, once God determines to do something, he lays out a plan on what is needed for that to happen, and then he does it. Before the foundation of the earth God determined that Jesus would come to save us all. So when this moment arrived Jesus planned to go to Samaria and talk to the woman at the well. To make that happen he traveled through Samaria consistent with His intent and as such he HAD to go through Samaria. Just as God has executed His actions through all history he continues to do the same for you in yoru life right now. He has given you the exact life you need, to be challenged sufficiently Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod  

Your time never gets a refund. Let AI watch that 53 minute YouTube. Full recap in 15 seconds. Plus, Michael is drowning in real estate contracts. I'm helping save $999 an hour on a lawyer by using AI. Learn more about your ad choices. Visit megaphone.fm/adchoices

This week, Paul argues that the one word that best summarizes the Bible is redemption—the story of God's rescuing, transforming, and restoring work through Jesus Christ, from Exodus to eternity.Join us for a weekly narration of Paul Tripp's popular devotional. You can subscribe to our email list to receive this devotional straight to your inbox each week, or read online at PaulTripp.com/Wednesday or on Facebook, Instagram, and the Paul Tripp App.If you've been enjoying the Wednesday's Word podcast, please leave us a review! Each review helps us reach more people with the transforming power of Jesus Christ.

866 You Will Not Go Away Empty-handed, A Guided Christian Meditation on Exodus 3:20-22 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable to do so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation Exodus 3 NIV 20 So I will stretch out my hand and strike the Egyptians with all the wonders that I will perform among them. After that, he will let you go. 21 "And I will make the Egyptians favorably disposed toward this people, so that when you leave you will not go empty-handed. 22 Every woman is to ask her neighbor and any woman living in her house for articles of silver and gold and for clothing, which you will put on your sons and daughters. And so you will plunder the Egyptians." 20 So I will extend my hand and strike Egypt with all my wonders that I will do among them, and after that he will release you. 21 "I will grant this people favor with the Egyptians, so that when you depart you will not leave empty-handed. 22 Every woman will ask her neighbor and the one who happens to be staying in her house for items of silver and gold and for clothing. You will put these articles on your sons and daughters—thus you will plunder Egypt!" Reflection on Scripture: Human ethics are not complete. For hundreds of years the Israelites had been oppressed. None of those past people saw relief in this life. Similarly in the time of Jesus, many Jews were persecuted as well as early Christians. Additionally there are people who suffer around the world, some of them children. In our human ethics this can be very difficult. Yet I think this presents a problem of perspective and what life is. With this perspective many people could argue that life isnt fair. If we consider this human life to be the totality of life then any discomfort during that time is injustice indeed. I am in the military and have had very unpleasant training periods. Additionally I asked a Marine recently if he thought that Marine Corps boot camp was fair, he did not understand the framing of the question. It didnt matter if it was fair was his response. It is very physically demanding and full of suffering but the framing of this experience in his mind was not about it being fair or not because he was doing it for the end result of going where he wanted to go in the USMC.  If we consider this life as a training period for us then it changes our whole ethical framework. Marine Corps boot camp was not designed to be comfortable nor was this life. So it is not a failure if it is not comfortable. The real question is, does it move us to what we need to move toward. For example for early Christians who were murdered for their faith, their ethics would be different. For example when they are in the presence of God for all eternity I seriously doubt that they will consider their lives to have been unfair.  In this scripture we see that God will eventually reconcile His children. He will avenge us of wrongs done to us with His mighty arm. He will forgive our wrongs if we come to Him with His power of grace. Not only that he will reward us for going through these challenges. We will be blessed beyond our understanding for the hardship we go through. This compensation the people received also allowed them to create a beautiful tabernacle unto the Lord. Trust that the Lord will reward every injustice in His way, not ours. Praise God that we will be judged according to His ethics and not our own.  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

This week I talk about why summarizing everything isn't actually reading more — summaries rob you of the experience, the context, and the ability to form your own opinion, and I'd rather read one primary source than 14 summaries I'll forget. Then a heavy but admirable piece from The Dispatch on Ben Sasse facing terminal cancer with poise, and what it teaches us about being present with our families, and a recommendation for Lou Gehrig's Luckiest Man speech on YouTube.Links:Don't Let AI Steal Your LifeBen Sasse Is Teaching Us How to Die—And Live—Well (The Dispatch)Lou Gehrig's Luckiest Man SpeechIf you enjoyed this, consider joining my newsletter at https://streamlined.fm/wrap. You'll get an additional Automation of the Week, as well as regular emails on how to approach building systems that help you take time off, worry-free.View the episode transcript (00:00) - Introduction (00:31) - On My Mind: What's the point of summarizing everything? (08:34) - Recommended Reading (13:57) - Recommended Media (15:30) - Outro ————Streamlined Solopreneur is the podcast for solopreneurs who want to automate their business and take time off worry-free. Each week, Joe Casabona shares practical systems, tools, and strategies to help you reclaim your time and run your business without sacrificing your the rest of your life, or your health. Start with the free Solopreneur Sweep — a step-by-step method for finding where your business is losing time: https://streamlined.fm/sweepIf this episode helped you, leaving a review on Apple Podcasts helps other solopreneurs find the show — it only takes a minute and means a lot.Connect with Joe on LinkedIn: https://www.linkedin.com/in/jcasabona/

Listen and subscribe to Money Making Conversations on iHeartRadio, Apple Podcasts, Spotify, www.moneymakingconversations.com/subscribe/ or wherever you listen to podcasts. New Money Making Conversations episodes drop daily. I want to alert you, so you don’t miss out on expert analysis and insider perspectives from my guests who provide tips that can help you uplift the community, improve your financial planning, motivation, or advice on how to be a successful entrepreneur. Keep winning! Two-time Emmy and Three-time NAACP Image Award-winning, television Executive Producer Rushion McDonald interviewed Dave Charest. Summary of the Dave Charest Interview In this episode of Money Making Conversations Masterclass, Rushion McDonald interviews Dave Charest, Director of Small Business Success at Constant Contact, a leading digital marketing platform. Charest discusses the rising wave of entrepreneurship, the foundational importance of email and direct‑to‑customer channels, common mistakes new business owners make, and how AI is reshaping small‑business marketing. He provides practical guidance on marketing consistency, channel selection, building community relationships, and using technology to scale. Throughout the conversation, Charest emphasizes that while small businesses often lack marketing expertise, they possess a valuable advantage: real, human relationships that can be strengthened through consistent communication. Purpose of the Interview The purpose of Rushion McDonald’s conversation with Dave Charest is to: 1. Educate new and aspiring entrepreneurs Charest breaks down the basics of digital marketing—email, social, SMS—and how to begin building a strong marketing foundation. 2. Highlight the key trends driving the entrepreneurship boom He explains motivations like work–life balance, independence, and financial potential that inspire people to launch businesses. 3. Provide practical, actionable marketing advice Especially around consistency, choosing marketing channels, and building direct customer relationships. 4. Introduce how AI can simplify and amplify marketing Charest showcases tools that help business owners quickly generate content, develop campaigns, and analyze customer behavior. Key Takeaways 1. Direct relationships (email/SMS) outperform social media Email offers ownership, stability, and higher ROI—unlike social platforms that can change algorithms or visibility overnight. Charest stresses that “the money is in the list.” 2. You don’t need huge numbers to be effective Small businesses often see high open and engagement rates because followers know and trust them. 3. Consistency matters more than platform choice Whether you choose Instagram, LinkedIn, TikTok, or email, the biggest driver of marketing success is showing up regularly. 4. Start small—don’t overwhelm yourself One of the biggest mistakes entrepreneurs make is trying to do everything at once. Begin with the basics and grow steadily. 5. Community is a crucial marketing asset Local businesses thrive when they maintain strong connections with nearby businesses, customers, and community networks. 6. Entrepreneurs face challenges—but resilience wins Charest notes that small business owners rarely have a “Plan B,” which pushes them to adapt and continue learning. 7. AI is transforming small‑business marketing Constant Contact offers tools to: Generate emails and content Summarize content for social Build full marketing campaigns Analyze behavior from large email lists to recommend actions Notable Quotes (from the transcript) Here are direct paraphrases and key phrases—not copyrighted material but drawn from the transcript: On email vs. social “There’s a $36 return for every $1 invested in email—but what matters is that you own the relationship.” “If a social platform goes away, so does your following. Email is a direct line.” On audience size “Big numbers aren’t necessary—small lists can see 50% open rates and strong engagement because those people actually care.” On entrepreneurship motivations “People want better work‑life balance, independence, and financial potential.” On mistakes “A big mistake is trying to do too much at once. Start small and stay consistent.” On community “Digital marketing should extend real relationships—not replace them.” On choosing platforms “Where your audience spends time matters, but so does where you can show up consistently.” On AI’s role “AI can generate emails, build campaigns, and analyze audience data—saving you time for what you’d rather be doing.” #SHMS #STRAW #BESTSupport the show: https://www.steveharveyfm.com/See omnystudio.com/listener for privacy information.

Listen and subscribe to Money Making Conversations on iHeartRadio, Apple Podcasts, Spotify, www.moneymakingconversations.com/subscribe/ or wherever you listen to podcasts. New Money Making Conversations episodes drop daily. I want to alert you, so you don’t miss out on expert analysis and insider perspectives from my guests who provide tips that can help you uplift the community, improve your financial planning, motivation, or advice on how to be a successful entrepreneur. Keep winning! Two-time Emmy and Three-time NAACP Image Award-winning, television Executive Producer Rushion McDonald interviewed Dave Charest. Summary of the Dave Charest Interview In this episode of Money Making Conversations Masterclass, Rushion McDonald interviews Dave Charest, Director of Small Business Success at Constant Contact, a leading digital marketing platform. Charest discusses the rising wave of entrepreneurship, the foundational importance of email and direct‑to‑customer channels, common mistakes new business owners make, and how AI is reshaping small‑business marketing. He provides practical guidance on marketing consistency, channel selection, building community relationships, and using technology to scale. Throughout the conversation, Charest emphasizes that while small businesses often lack marketing expertise, they possess a valuable advantage: real, human relationships that can be strengthened through consistent communication. Purpose of the Interview The purpose of Rushion McDonald’s conversation with Dave Charest is to: 1. Educate new and aspiring entrepreneurs Charest breaks down the basics of digital marketing—email, social, SMS—and how to begin building a strong marketing foundation. 2. Highlight the key trends driving the entrepreneurship boom He explains motivations like work–life balance, independence, and financial potential that inspire people to launch businesses. 3. Provide practical, actionable marketing advice Especially around consistency, choosing marketing channels, and building direct customer relationships. 4. Introduce how AI can simplify and amplify marketing Charest showcases tools that help business owners quickly generate content, develop campaigns, and analyze customer behavior. Key Takeaways 1. Direct relationships (email/SMS) outperform social media Email offers ownership, stability, and higher ROI—unlike social platforms that can change algorithms or visibility overnight. Charest stresses that “the money is in the list.” 2. You don’t need huge numbers to be effective Small businesses often see high open and engagement rates because followers know and trust them. 3. Consistency matters more than platform choice Whether you choose Instagram, LinkedIn, TikTok, or email, the biggest driver of marketing success is showing up regularly. 4. Start small—don’t overwhelm yourself One of the biggest mistakes entrepreneurs make is trying to do everything at once. Begin with the basics and grow steadily. 5. Community is a crucial marketing asset Local businesses thrive when they maintain strong connections with nearby businesses, customers, and community networks. 6. Entrepreneurs face challenges—but resilience wins Charest notes that small business owners rarely have a “Plan B,” which pushes them to adapt and continue learning. 7. AI is transforming small‑business marketing Constant Contact offers tools to: Generate emails and content Summarize content for social Build full marketing campaigns Analyze behavior from large email lists to recommend actions Notable Quotes (from the transcript) Here are direct paraphrases and key phrases—not copyrighted material but drawn from the transcript: On email vs. social “There’s a $36 return for every $1 invested in email—but what matters is that you own the relationship.” “If a social platform goes away, so does your following. Email is a direct line.” On audience size “Big numbers aren’t necessary—small lists can see 50% open rates and strong engagement because those people actually care.” On entrepreneurship motivations “People want better work‑life balance, independence, and financial potential.” On mistakes “A big mistake is trying to do too much at once. Start small and stay consistent.” On community “Digital marketing should extend real relationships—not replace them.” On choosing platforms “Where your audience spends time matters, but so does where you can show up consistently.” On AI’s role “AI can generate emails, build campaigns, and analyze audience data—saving you time for what you’d rather be doing.” #SHMS #STRAW #BESTSee omnystudio.com/listener for privacy information.

I'm excited to work with Microsoft once again as the presenting sponsors of the AI Engineer World's Fair! We'll streaming live from MS Build today for a special crossover pod with our friends at No Priors and the one and only Satya Nadella. However we did not hold back with this interview - we asked all the burning questions about uptime and Copilot that we know you have in your minds. Lets go!For almost two decades, GitHub has been the home of software, where both open source and closed flow, through commits, pull requests, reviews, actions, etc.This ecosystem flourished as open-source maintainers and contributors would continue shipping code for the benefit of the community. However as coding agents began to ship mass quantities of code - growing 1400% in 2026, it marked a new era that was both extremely exciting and challenging for GitHub.While these agents help more people ship more projects, they also significantly increase the floor of how much code is shipped, how often it is shipped, how many people commit code, and basically orders of magnitude multiples in every dimension of GitHub infrastructure:Now GitHub inevitably experiences more pressure on their infrastructure which was originally designed around human developers moving at human speed. This has resulted in a very publicly notable uptime story:So it begs the question of whether current systems around code can absorb what AI produces. Can CI/CD keep up when every idea becomes a build? Can open source maintainers survive floods of AI-generated slop contributions? Can GitHub preserve the human social contract of software while becoming the operating layer for agents?Which brings us to the perfect person to answer these questions: GitHub COO Kyle Daigle. In this episode, he joins swyx to unpack what happens when AI doesn't just autocomplete code, but starts changing how companies operate, how open source works, how pull requests get reviewed, and how GitHub itself has to scale. We go deep on GitHub's internal AI workflows: micro-skills, WorkIQ, MCP, Slack, Teams, email, Copilot workflows, the new Copilot desktop app, CLI, cloud agents, and how Kyle uses agents to look backwards across company context before deciding what to do next. Kyle also reflects on GitHub's history building webhooks, APIs, Actions, npm, Dependabot, and Semmle, why the AI era is breaking GitHub in new ways, how Actions became a general-purpose compute layer, and what Copilot becomes after code completion.Full Video PodWe discuss:* Kyle's expanded role across GitHub* How AI got Kyle coding again after years in leadership* Why GitHub rolls out AI through existing workflows instead of forcing new tools* WorkIQ, MCP, Slack, Teams, email, and GitHub as company context* Why massive “mega-skills” are giving way to small, atomic micro-skills* How AI changes summarization, communications, marketing, and analyst work* Why former developers in leadership may have a unique advantage in the AI era* Kyle's “15 agents on Saturday” workflow* How Kyle built an AI-generated executive presentation for CRO/CFO teams* Why AI changes the chief of staff role without removing the human work* GitHub Actions, webhooks, arbitrary code execution, and secure agent compute* The npm acquisition, supply-chain security, 2FA, and token invalidation* Slop forks, vendoring, and whether AI agents change dependency management* What pull requests become when most PRs come from agents* Prompt requests, vouching, AI review, and trust in open source* What counts as a “developer” when AI lowers the barrier to building* GitHub Spark, low-code, and why GitHub refuses to hide the code* 14x commit growth, Actions load, databases, monorepos, and availability* Copilot's evolution from completion to CLI, desktop app, cloud agents, and SDK* Context, memory, rules, and making GitHub “act like Kyle wants it to act”* Ambient AI, OpenClaw, enterprise security, and the new operating system for agents* What swyx should ask Satya Nadella about Microsoft's AI futureKyle Daigle* LinkedIn: https://www.linkedin.com/in/kyledaigle* X: https://x.com/kdaigleTimestamps00:00:00 Introduction00:03:36 Why AI Got Kyle Coding Again00:07:04 Running GitHub with AI: WorkIQ, MCP, Slack, Teams, and Skills00:15:39 The Golden Age for Former Developers in Leadership00:17:31 15 Agents on Saturday and AI-Generated Executive Work00:20:20 How AI Changes the Chief of Staff Role00:21:45 GitHub's History: Actions, npm, Webhooks, and Open Source00:28:45 Slop Forks, Vendoring, and AI Dependency Management00:33:57 Pull Requests, Prompt Requests, and Trust in Agent-Generated Code00:41:21 GitHub Stars, 200M+ Developers, and the New AI Builder Wave00:45:15 GitHub Spark, Low-Code, and Why GitHub Still Shows the Code00:47:38 GitHub's Hardest Era: 14x Growth, Reliability, and Scale00:59:21 Actions as the Compute Layer for CI/CD and Automation01:02:04 The State and Future of GitHub Copilot01:08:24 Ambient AI, Background Agents, and the Future of the SDLC01:13:09 OpenClaw, Enterprise Security, and the New OS for Agents01:18:03 Build Announcements, WorkIQ, FoundryIQ, and Microsoft Context01:21:41 What Should swyx Ask Satya?TranscriptIntroduction: Kyle Daigle's Expanded Role at GitHub and MicrosoftSwyx [00:00:00]: We're here with Kyle Daigle, COO of GitHub. Welcome.Kyle [00:00:07]: Hey, thanks for having me.Swyx [00:00:08]: You're not just CEO of GitHub. People know you as that. You have a new role.Kyle [00:00:11]: So I have an expanded role now. I've been working at GitHub for thirteen years and doing all things developer. Joined as a developer myself. And now, I'm also responsible as the CMO of Developer for Microsoft. And so all the kind of learnings and passion for developers and how we work with them and how we communicate and how we bring our products to market, we're also bringing that expertise to the broader Microsoft ecosystem and helping every developer that uses a Microsoft product or would like to have a sort of similar experience that they've had with GitHub over the years. So it's a different role in some ways, but it's also just building on the experience that I've had at GitHub of just sort of tell the truth, be authentic, show people how to use it and then let the products speak for themselves. Now just doing that with, all of Microsoft.Swyx [00:01:09]: We'll be releasing this in conjunction with Build. You got lots of stuff planned, and we can sort of touch on that whenever it's appropriate. I think one of the interesting things is I rarely meet a COO who's also a CMO. I think you're a very outward facing and you're very confident publicly. That's rare. Do you actually view yourself as COO? What's What is your thing?From GitHub Developer to COO/CMO: Building the Platform and Operating GitHubKyle [00:01:33]: I think for me, it's been funny. The titles have always been, a— have always felt a little strange to me. I joined GitHub as a developer? I wrote so much of theSwyx [00:01:46]: Let's bring that up. You wrote the back ends?Kyle [00:01:48]: I was going through, I was going through, some old photos, when folks were talking about how things were being built or how there was a build GitHub. I built, webhooks and worked with teams building the API, built the platform layer. Anything that integrated with GitHub, up until really twenty eighteen, I built or ran the engineering teams. And that's kind of where my the beginning of my passion always was helping people build things, deliver them to, their customers. And so being a developer, building for developers was always super unique. In a— I think as my role expanded, it became my ability to talk to not just developers, but also enterprise customers or business leaders and have this translation layer. And then through all those years, GitHub has always operated pretty uniquely. Post-pandemic, working remotely was not as novel as it was when GitHub started in two thousand and eight. But all that expertise of running remote teams, doing it well, became this sort of bigger role, ultimately turning into the COO role of how do we operate GitHub in the way that GitHub's always operated after the Microsoft acquisition. And kind of so on from there. So like for me, I think the— I've, I still code. I love coding but the problem has always been, people. It's a much harder problem to both support our own employees, a harder problem to communicate to developers and enterprise buyers what we're building why it matters, ‘cause those are two very different messages. And so getting to work in the mix of COO, CMO, also just being a dev, I think is what's kept me at GitHub for so long.AI Workflows for Leadership: Commits, Retrospectives, and ContextSwyx [00:03:40]: Apparently, you have— your commits have gone up. What's this? What's going on?Kyle [00:03:45]: Rui's called me out pretty aggressively. So I think— as you can imagine, right, you can see my normal era of being a dev In the twenty thirteen, twenty fourteen era, and then moving into management, and then ultimately the COO role. I think what you see there is me, really getting back to coding thanks to AI. I— similar to, attaching problems between how to market and how to operate a business and how to code, I find, building agents and workflows that are connecting very disparate problems to be what's driving this. So that's, some of it's writing software. A lot of it is, connecting a ton of a different data sources to, help me out. But that is completely me really diving in on the AI side in trying out our tools, trying out everyone's tools, But building for me, building for the non-technical leader, though I'm technical and how we're, able to use these tools more than just the simple, call and response that I think a lot of the non-technical, your employers, you have to get— you have to use AI, and so everyone uses, ChatGPT or Copilot or Claude or whatever. To really get into, how is this going to help me out, it— I find that it's not the I need to write a blog post, I need to those simple examples. Helping people find the workflows of, “Okay, I need you to go through all the PRs today. I need you to go through everything that we've posted online. I need you to go through what we did the last three months. Go through all of my Obsidian notes for any mentions of this then go through my transcripts at work.” We use, Teams, so, using WorkIQ, go call that MCP server, grab all the transcripts, go through all the Slack, and then build me out the plan of, what this week's messaging actually was. That's something that was, impossible because for me, I find AI in a what most of this launch here is actually, less building forward. It's actually, a recursive loop backwards. I'm always looking at what had happened first. Go back through the week and tell me what we did, what worked, what didn't work? And then tell me in the next three or four days-What would you tweak based on this sort of like looking backwards and then looking ahead a little bit? I find that to be so much more valuable, especially for like non-technical, because that retrospection is actually LLMs are very good at that. Like finding all the patterns, pulling them out, and then applying that retrospection to just a couple of days or just like a short period of time. Is all a bunch of apps that I've built and launched a bunch of, internal tools. I use the new, GitHub Copilot app, the desktop app with workflows. Every time I crack open my laptop, it's running workflows for me. It's just a ton of different stuff and of course, it all ends up on, it all ends up on GitHub.Swyx [00:06:47]: Of course. That's where, that's where, stuff is hosted. Man, there's so much to ask you. I was going to leave the how do you run a company with AI thing at the end. I have to ask one— double click one thing. You said, you are looking back at the week. You're, you're understanding what happens. When you say we That's three thousand people. How?Rolling Out AI Internally: Skills, CLIs, and Company ContextKyle [00:07:09]: I think when we started rolling out AI internally beyond engineering, right? One of the things that I was really, passionate about is like we have to do this in a way where no one has to change how they work. I don't want to have to teach you a tool. I don't want to have to teach you something new. And so for us, we tried out a few tools. Most of them don't work because I got to get you on board? I got to teach you how to use it. What we've actually ended up doing is we've built like a set of skills internally. We have we each have our set of skills, and we've just been distributing even to the non-technical folks, the CLI. And then effectively, we're just giving it access to like read about everything that we're writing. So that's for us, that's usually GitHub, Teams, Email, and Slack. So Teams for, video chat, generally speaking.Swyx [00:08:03]: Teams and Slack?Kyle [00:08:04]: so we use Teams for video communication, but we don't use it for chat. W-we— GitHub for a long history, right? We're alwaysSwyx [00:08:13]: Also SlackKyle [00:08:14]: Talking about ChatOps and like everything is built into Slack. Like every command, every flow.Swyx [00:08:18]: So even though you have been acquired for I don't know, eight years nowKyle [00:08:22]: we stillSwyx [00:08:23]: You still use Slack?Kyle [00:08:23]: it's a purpose-built tool for us, and I think the reality is that moving off of it would be so bluntly expensive? Simply because all the tooling is, baked in with that paradigm. And they both have their pros and cons but they don't work the same way at all. We still use a bunch of different tools Because it's the purpose-built tools that We need. And thenSwyx [00:08:47]: Well, the same doesn't go for the rest of Microsoft, presumably.Kyle [00:08:50]: like the like various teams like operateSwyx [00:08:53]: They make their own decisionsKyle [00:08:54]: Various ways. I think it just matters what you're trying to what you're trying to do. But we do we do work across kind of every tool that we use, and then by giving everyone access to all of that context and the new WorkIQ MCP server, which is quite cool if you do live in the M365 like world. I can ask it all these backwards-facing questions, and it's incredibly important for our teams that are working remotely. There's a lot of stuff you miss when you're not in an office, and we are spread out all over the world. So most of that is looking back. And then we post, we post either auto-automatically into GitHub issues or discussions, these sorts of like findings or like our industry reports. Like what's happening this morning, today, yesterday. A little automation gets run. We'll use the app. We might use GitHub Actions like with, our agentic workflows just to go do that run, and then we push it into GitHub, and w-we keep having a conversation. So usually for us, it's about that sort of like looking back, looking forward on the non-technical side. And then of course for a lot of those folks, it's also building an app, pushing it to GitHub pages or pushing it somewhere to host it et cetera. But it's just like enabling everyone with that power of it's going to take me a week to figure this out. Instead, we're going “Okay I built a skill. Let's put it into a repo. We'll all share that skill together, and then we'll use the CLI or now the app-” “just to run it.”Micro Skills vs. Mega Skills: How GitHub Uses AI at WorkSwyx [00:10:26]: All right. I think, I think we're going straight into like the team management and productivity thing. I think a lot of people are getting various levels of LLM psychosis. How do you manage the bloat of skills? Like everyone Has their thing, and they're Like trying to promote it to the rest of their peers in their org, right? And obviously, whoever becomes a skill influencer internally becomes like an AI leader, right? Of sorts. I assume you have those.Kyle [00:10:50]: like I think we haveSwyx [00:10:52]: And I assume it's a mess a Yeah.Kyle [00:10:54]: there's like I— like I think the reality is there's two pieces. Like first is I think that we're ending the era of these like massive, beautiful, perfect skills that are just like not any of those things. ‘cause for a while, right every tweet every day is like go download the skills, the perfectly managed thing to do this entire workflow. And I think that like what we've found and what— I was just with my team, this week, and we were talking about the skill side, and we're really talking about these like incredibly micro skills that are just doing one thing for us very well Versus a skill that's going to do I said, that full report. That doesn't really exist on our side anymore. It's usually how do— like a single skill that's going to identify the most important marketing information given any MCP server. Like this is the most important thing. Less about stitch a bunch of tools together and have it produce this mega output because then weeks go by, months go by, things change, and you want to tweakSwyx [00:11:58]: It's brittleKyle [00:11:58]: Your mega skill and you're screwed? You can't do that. And so now we're really just talking about the Legos we're using and just letting the instruction book be something we're all putting together. Whereas I think a lot of AI skills for a while have been that mega instruction book style.Swyx [00:12:15]: I've, thought a lot about Postel's law. I don't know if that's a term that is, means things to folks. It's the idea that you should be liberal in what you accept and strict in what you output, right? And I think that's like a good framing principle for skills. This is my skills, obviously on GitHub. I feel like everyone should have like how like some repos In GitHub are special repos? I feel like we should sort of reify the slash skills and everyone like give it some kind of special presentation. Anyway, so, yeah, this is one of those like download Download anything, transcribe anything, and then you can string together the atomic skills that do one thing well Into like some kind of orchestration skill that calls other skills. I assume, does that match?Kyle [00:12:56]: I like I think so. I think that theSwyx [00:13:00]: Summarize anything.Kyle [00:13:01]: Like I think the- For me, summarizing something for I do communications and PR and analyst relations and marketing and customer activities, and so my summarize everything is very different for each one of those like Contexts. What ‘Cause if I'm summarizing something for an analyst, that's a very different thing than, probably how I'm going to summarize something for like a customer meeting or an engagement. So that's I think like the difference when we're talking about the like the tools I might use on Saturday or the skills I might use on a Saturday when it's just for Kyle. Yeah, those are kind of like they have an atomic actual tool underneath or maybe skill, and then Kyle cares about X. But I think when we're talking about work and enabling the the marketers, communicators there, it's the atomic, this is what good summarization is, and then this is what I care about as for marketing for communications For whatever. And that I think is like the interesting matrix problem when we go from like a developer set of concerns to all kinds of different professions, is that what that word means to me is different than it means to you is different than it means to the analyst or the salesperson, and that's where I think the matrix mess is that we're starting to like still starting to find. It's about these mega skills but they're all just slight permutations, but those permutations are really important. It's the difference between someone reading this and going “Did AI make this?” what Or “This makes total sense, and I would expect this when I'm giving a briefing to Gartner,” or like whatever else.Swyx [00:14:37]: I think the beauty of it maybe is that you don't have to be that careful about what goes in there. It doesn't have to exactly fit as long as it like roughly is contained in there. I used to complain about plugin hell, basically. Like when you have a framework and then you have a hundred things that you need to integrate, everyone does like the GitHub used to be bloated full of these things. And now we don't need them anymore ‘cause now you just use skills.Former Developers in Leadership: AI as a Creation MultiplierKyle [00:15:00]: And like I think the most magical thing is the just that like I can just also crack it open. Like Like yes, I could go like change the how the plugin is coded, or like I could go do that now with AI, but I think there's just something more magical about getting a response back and being “That's not right,” and then you just crack the skill open, you just type English words and it's different. That building block is just, I think very unique. Once I get everyone to kind of understand how to best how to best make those changes to get the most power out of them.Swyx [00:15:36]: Is there a— you have a your peer group that Of people like you. Is there a common framing for Something I'm feeling is, which is true, is that is this a golden age for former developers who are now in leadership? Because you can wield the tools, you would know the right words, you're maybe not too close to the details. Doesn't matter. But like you're more effective than someone who doesn't come from that background.Kyle [00:15:59]: I think that like the secret has always been your ability to identify patterns and solve problems, and I think that for folks that like myself that don't code day to day anymore, that has made me successful as a developer, made me successful as a COO and now CMO. And so now that I have access to get and write code, I'm now applying that sort of like pattern finding and problem solving, and I know enough still about how to then go and say, “Oh, I want to make an app, but I don't want to break into jail or create something that's not going to be able to work or to be deployed scale or whatever.” that ability to apply all that additional business knowledge and still code I think is what makes that so interesting to me. Slightly different than I think some of the other like technical leaders that became business leaders and now are going back to their apps and updating them. Good for them? But I think the more, much more interesting thing is, well, now I have this whole new set of expertise over ten plus years. Why not take that and use that as a developer with these AI tools? So I definitely think that makes me more powerful, but I think that's true for like every dev as well. Most of the dev friends I still have also have some other underlying skill and passion. There's really talented, very kind of linear computer science software devs, absolutely. I just find that the folks that came from a different career, went to school for something else, went off and did this random thing, and then became a software dev, or were a dev, did a random thing, came back. Learning that extra set of information, learning those extra skills, and now having the power of an AI where I can crank up fifteen agents on Saturday while my kids are doing lacrosse, That's like really powerful. And I think it gets me back to that feeling of like creation, and it's very hard to replicate that in most other senses? That first time you build an app and you click it and you show someone that's magical. And so being able to do that not just in code, but across all kinds of different assets that's, that's huge. We were doing we're doing our every year we do our revenue planning. We talk about okay, what is it going to look like for next year? And of course as you imagine, there's, slideshows everywhere talking about what are we going to talk about, what's the narrative, et cetera. And so as you said I'm “Okay, well, I could probably just like build something to build this and then that way I don't have to go build the whole spreadsheet or I have to pass it to my team.” So we went through this process, and I got all the information and used the skills I mentioned. I built like a little app just to make it so I could look at some of the information in a SQLite database, more easily. And I ultimately built this entire presentation without touching any of it and I was “Okay, I'm just going to present this to our CRO, the CFO, their teams,” without mentioning I'd built it with AI. I like built a skill to make it look very much not AI driven. Just not pretty.AI-Generated Presentations, Human Taste, and the Changing Chief of Staff RoleSwyx [00:19:03]: Like a design. Yeah.Kyle [00:19:03]: Not pretty. But just like very clearly not AI. Kind of like don't do anything interesting.Swyx [00:19:08]: That's, yeah, that is valuable.Kyle [00:19:08]: Just go Exactly. We did the whole thing through. It used my notes from Obsidian, it used all the context I mentioned before, the plans, and Never came up once that it was AI generated.Swyx [00:19:20]: It didn't matter.Kyle [00:19:20]: Never once. D It didn't matter. And so now I takeSwyx [00:19:23]: This is a toolKyle [00:19:23]: I can take that tool and go, “Look, I don't want you to go build slideshows.” They're just helping us share information with each other. If this thing can do it With a little bit of crafting from you and then we can look at it together, awesome. There's no value in all that extra work. I think that the ability to, make it look humanly bad and and build a little app to, manipulate the data I think is part of, that upside for devs that are now in leadership roles. Because, the thing that I feel like I said before, this that's all a people, that's all a people problem. I know if you've used a coworker or not to build a slide deck, unless you spent a bunch of time to not do it.Swyx [00:20:07]: I know, but like it was so, I think there's a certain charm to just being blatantly AI. ‘Cause I think that you're well, you're just honest about There may be mistakes here that I cannot vouch for. So how much value is there? But anyway I think, actually the real question I want to ask is, there's a— You were a chief of staff To Thomas. And in the pre-AI world, the that job would've been a chief of staff job of like Can you prep me these slides and all that? And now you do it yourself.Kyle [00:20:35]: I still, I still have a chief of staff. Because, the difference is it's sort of the discussion every time we have some sort of technology evolution is it's not that the jobs the roles don't all go away, they just change? And so yeah, I don't have someone spending all their time building out slides for me and presentations ‘cause I don't need that anymore. But now I need that person that is able to go and find all the different connections between humans in those discussions to help me find out, okay, I should be meeting with this group and this team, and they have an opportunity, and I'm going to be in San Francisco today, I'm going to be in Seattle tomorrow. Those sorts of human connection aspects are still incredibly valuable and has always been a big part of that chief of staff role. But now just like chiefs of staff are not opening up, letters to process, they're doing emails. What It's the same thing. And now they're, they're not building out as many of these presentations because they have the the ability to have a AI take it on for, and share that with me and great. Let's keep moving ‘cause it's allowing us to go faster and make better decisions more quickly.Swyx [00:21:45]: Awesome. Well, so we can dive into more sort of, Productivity insights as you go. I did want to do a little bit of a brief history of colleague and hub. Because, we started here. And then you also involved the NPM acquisition. I did, I do want to touch upon that. And then more recently, I just want to bring up to present day where we're having uptime issues Which transparently we've already Addressed publicly, but we'll, we'll discuss in the pod. Did I miss anything? Like what, any other major highlights? Obviously, it's, it's a lot of years to cover.A Brief History of GitHub: Webhooks, Actions, Acquisitions, and Platform EvolutionKyle [00:22:15]: No the I think one of one highlight was right before the acquisition closed in twenty eighteen, I got to launch the first version of ActionsSwyx [00:22:27]: OhKyle [00:22:27]: At GitHub Universe. So it was OSwyx [00:22:29]: They're that young?Kyle [00:22:30]: It was October of twenty eighteen, I think. Yeah. Yeah.Swyx [00:22:33]: Gee, Jesus.Kyle [00:22:34]: I got to I was the engineering leader on that project and got to launch that. And then, yeah, we did acquisitions of NPM you said, Semmle, Dependabot Pul Panda a whole bunch of things. That was a bigSwyx [00:22:47]: Pul Panda.Kyle [00:22:48]: Abi is doing well.Swyx [00:22:51]: DX. Holy crap.Kyle [00:22:52]: Did well on DX. I and like that was a that was the big shift, after the acquisition. I had to join the sort of business side.Swyx [00:23:00]: So I need to hit you on some of these things ‘cause you were there. Right? And how often do I get to talk to someone who was there? But yeah, Actions. Is that the number one source of security issues on GitHub?Kyle [00:23:11]: Oh, sh I think that the number one source of, security issues is probably like all, the literal code in everyone's like underlying repositories. I would say back further than that is, if you remember I had to show in this graph was this is, I'm, didn't say this before, this is ultimately webhooks.Swyx [00:23:30]: You yeah.Kyle [00:23:31]: Like circa whatever it was.Swyx [00:23:32]: It says Hookshot in there.Kyle [00:23:32]: I forget. Yeah. Yeah, Hookshot's in there. And so like back then, it says GitHub Services. Do you see, it says Hookshot FE for front end, and then it says GitHub Services. GitHub Services back in the old days, right? You we had a repository that was Ruby code, and you could write any Ruby code in there, and then we would execute that On your behalf As a service, and then that way if an if you were trying to integrate with something, it didn't we would run it for you.Swyx [00:23:57]: And of course no containers ‘causeKyle [00:23:58]: No, ‘cause it wasSwyx [00:23:59]: Well, no containersKyle [00:24:00]: Twenty fourteen. And so there was some isolation obviously, but it was mostly the separations on the server level. That's like an example as long as the very old version of Pages, which ran on its own containerization infrastructure, not on Actions.Swyx [00:24:15]: Which like all-time great product.Kyle [00:24:16]: Pages powers the internet at this point to some degree. Those were places where like clearly there were no like issues like to my knowledge. But it was those things where I'm looking at and going “Okay, well we can't be running arbitrary Ruby code,” like on everyone's behalf. Then containerizing all of that up intoUh into actions now where yeah the containerization, is r-really good. The pinning most folks aren't pinning it the like to a particularSwyx [00:24:48]: ImagesKyle [00:24:48]: Sha, et cetera like their workflows, and so that's a big that's a big place Of pain for folks if they're just doing similar to any dependency management, just V1 or newest or latest, I think. But, that journey from that day to “Okay, we're just going to run all this arbitrary code, and, it'll basically be okay,” to now, no, we have, really good containerization. We have a new, underlying, ag-agent, containerization, service. It's like we're using it under the hood. It's through Azure. They recently announced it. The Azure, Dev Compute, but it's, very fast, very fast compute to be able to, spin up your own cloud agents, or whatnot. We're using it under the hood for some parts of the new,Swyx [00:25:36]: Microsoft Dev Box?Kyle [00:25:37]: No. Dev Compute, yeah.Swyx [00:25:41]: Hmm. Not finding it just yet.Kyle [00:25:44]: Oh, it's, it's in there somewhere.Swyx [00:25:46]: All right. Well, we'll cut that out.Kyle [00:25:47]: Sorry. But with, Dev Compute, you can, run, really fast, spin up really, small VMs really quickly, so you're doing a tool callSwyx [00:25:58]: Same conceptKyle [00:25:58]: Just do it containerize exact-exactly. So we're using that so definitely moving that direction to protect us from every every piece of code that we're ultimately running.Swyx [00:26:07]: look, that grows into the full SDLC? Code hosting was just the start and and then it's grown beyond that. Let's talk about NPM may-maybe ‘cause I think that's also, a very major point in the industry. I do think, it was looking for a home. It was, kind of struggling as a business, right? I don't know, I don't know how you would characterize that whole acquisition and how itNPM, Package Security, and Keeping the Internet RunningKyle [00:26:33]: like when we were talking to the team, I think the big thing for the both of us was to find a way to keep NPM, which was basically powering the internet then and way more so now to some degree running. Keep it going keep continuing to scale. It was having scaling problems, if I recall, back at that time. They were doing some rewrites. ItSwyx [00:27:00]: that's cute compared to now.Kyle [00:27:01]: Well, that's the thing is like when I'm talking to folks now, there's there's so many more underlying uses of NPM than there were back when we had them join in with GitHub. But that was ultimately the goal. It was really okay, we used to have pages. We have, the world's code. Let's make sure that we can keep NPM running well for the world. And we put a bunch of time and investment into fixing some of the underlying backend, changes, some of which we talked about some of the manifest work, et cetera. And then now, really trying to bring the the security posture of NPM up to speed. But, it is a unique challenge in that every move that we make to make it more secure will break a lot of people. And security is paramount. And also, we take it very seriously. We're, the any time that we have a problem with GitHub or we make a change that makes us more secure but hurts, there's, a snow day for developers or a really bad fire that they have to go put out. And so we've, have changed the 2FA policies. We've changed the way the tokens work. When we find tokens that have been exposed or potentially, exposed, we invalidate them, andSwyx [00:28:22]: I love that feature in GitHub. Yeah, it's greatKyle [00:28:23]: That creates issues, but, the but that's the thing is we're trying to push the community, forward without necessarily, doing something that is going to break the contract that's been for 15 years or close to it or some amount of years on NPM.Slop Forks, Vendoring, and the Future of Open Source Supply ChainsSwyx [00:28:43]: I think the— So now we're talking about, open source and publishing. And I think there's something here with what people are calling slop forks, which, I think Malta from Vercel is doing. And, part of me thinks, well, the way to get past any vulnerabilities, we just, let's just get rid of the concept of NPM. And we only publish source code. And anytime you want to import it you have your coding agent look at it and then adapt whatever subset you're going to use into your vendor it. But, the AI vendor it. Is that realistic? I don't know. Is it— Will that solve all our security issues? I don't know.Kyle [00:29:24]: I don't think it'll solve I so Mitchell was just talking Mitchell Hashimoto Was just talking about this today, and I think that I-in some ways, it's all all things, old or new again? Yeah, absolutely vendoring everything. Like I do I do remember twenty thirteen, twenty fourteen.Swyx [00:29:42]: This is Yeah. Let's, we must return toKyle [00:29:43]: That's what is We were vendoring everything. We were having actual discussions around, or at least I remember we were “Should we take this full thing?” “Why is this so big? We only need this one file.” And so I do think there's something true there where having either taking only what you need or the dependencies just getting incredibly small over time, I think will help to some degree, but it's not going to solve the fundamental problem, I don't think, because the vulnerabilities in an agent looking at them, there's time and time again, there's a million different ways in which we can convince an agent that this thing is, secure or not and pull it in. Or we can do static code analysis or runtime testing to say whether the code works or not. That is, I think, the step that needs to continue to be, invested in. The question is just on, how much scope. Should it be this enormous project that I'm pulling down, or should it be this piece? Either most companies are running some amount of security checking on the on the packages that they're bringing in or vendoring. That I think won't change. That's like what advanced security does to some degree, Socket does some degree. Like everyone is doing a piece of that. How we each do that like especially when we're talking to enterprise customers, is just like very different. No there's no one wants one single way to do it. And I think that's always been GitHub's, unique position in the world. I talk a lot to maintainers, I talk a lot to folks about this. It's we're— we rarely start like a process and a practice and like push it onto the community. We usually wait for the sort of like RFC process socially or literally, everyone agreeing, and then we'll cement something in. Because otherwise we'reMaintainers, RFCs, Vouching, and the Social Layer of TrustSwyx [00:31:35]: That fits your role in the ecosystem, yeahKyle [00:31:36]: We're GitHub. Yeah, we don't want to shape the whole thing. We want it to be figured out. But like how do you balance that like sort of Role in the industry to keep everything as secure as is possible and make sure that you're you're not going to be compromised as a human, ‘cause that's usually how it all happens. And Not not create a process or lock us into a flow that you're not going to or like Mitchell's not going to or other open source projects aren't going to like. That's always been a tricky balance for us, and I think that's something that we haven't talked about enough is we're not going to be able to fix everything for everyone in a way that everyone is going to like. So tell, help us, tell us what is working. When Mitchell was talking about, the Upvote, the upSwyx [00:32:22]: I was going to bring up his thing. Yeah.Kyle [00:32:23]: I forget what it Yeah. When he's talking to us, I was chatting with him and talking to him about this and I put it on Twitter and we talked to, also over DM, was “We're going to keep working.” but I think the important thing is I do actually want to hear what isn't working for you. And as, be as specific and clear for your project as is possible. And to every piece of credit over the many years that we've known each other through the industry, he's always done that and I appreciate that ‘cause there are places that we need to fix up, and we hear from him, and we'll fix up just like we do all other kinds of maintainers. But that that process between making those types of improvements and being more secure and like creating, I forget what he calls it's not the proof process, not the claims process. Do what I'm talking about? He has that he his projects have a way for you to kind of like,Swyx [00:33:13]: VouchKyle [00:33:13]: Vouch. Thank you. Yeah. He has like the vouch system for saying, “Hey, you should accept my PRs.” That's beenSwyx [00:33:20]: I just built this into GitHub. I don't know.Kyle [00:33:22]: Well, see, but that's the thing is that you say that and like he and his community really likes this and then I'll go talk to other maintainers and other maintainers, globally, and they're “No, this doesn't work for me.” And that is the tension, but also the kind of beauty of GitHub, depending on which way you look at it is we want to help maintainers, so we create all these tools to let you have more control over how much you take in from AI and PRs. But you can also use this. What You can go use this project, and if it takes off and becomes the kind of mostly standard, then yeah, we probably wouldn't enforce it but we would add it in because that's the flow that we tend to do?Swyx [00:34:02]: I hear a lot of people don't know the history of the pull request. And like like that's how, that's something that GitHub standardized basically.Kyle [00:34:08]: Yeah. It was a very messy process Like beforehand, and now the we have the benefit of it being the process? And now we have to go and Figure out the next best process or what adaptations change, or what does a pull request look like when eighty percent of your PRs are just coming from your agents and not From other devs?Swyx [00:34:31]: Do you like the prompt request idea from Peter?Kyle [00:34:34]: like I think that for each like each idea I think has its merits. I'm not, I'm not avoiding saying anything good or bad, but I feel like I've seen a version of we have that we have entire Thomas' store. Take all the assets of what you've built and put that in. I think that's got great ideas. There's all these various permutations of the PR flow, but I think the reason why there's not a single answer is ultimately we're trying to codify trust. We're trying to say “Okay, if Sean reviews this I'm going to trust it because you're Sean or you're the senior dev or you're the whatever.” And right now, when we are working in a flow where an agent writes code and another agent reviews code and then Kyle goes and looks at it the trust is kind of diffuse. And most of the tools that we're talking about are talking more about verification flows. We have more assets to look at, so I can probably say whether this is a good PR or not. But that still doesn't solve, I think, the human problem of I'm looking at a PR and I want to know if I can trust it. And we're still, we still tend to use human signals for that? Mitchell approving it or Kyle approving it or whatever. And so I think that's, I think that's why most of these options haven't really solved it is because, it's a social problem ultimately. It's a it's a human problem to review it and agree. Or you fully trust the tool and you're imbuing that tool with full trust Which I think in some cases that absolutely exists.AI-Generated PRs, Trust, and the Waymo AnalogySwyx [00:36:08]: And so like in the same way that there will be a tipping point in society when we don't allow humans to drive anymore Because machines are measurably better than Than humans. I'm looking for that tipping point, right? Like Mythos is ridiculously expensive. Someday we'll have Mythos on a desktop. I don't know. Will, does that change the equation?Kyle [00:36:30]: I think it's more I took a Waymo here, and I was on my phone and not looking around at all. There are other, self-driving, vehicles that I would not trust while, staring at the road. And I think that trust is something that isSwyx [00:36:48]: Is this a Zoox thing? What is itKyle [00:36:50]: I think that is both. I think that is both. LikeSwyx [00:36:53]: There's Zoox in this robo taxi. That's it. It'sKyle [00:36:56]: Well, depending on what level Of self-driving. But, my point is sort of that I think part of that is I strongly believe that's, a mixture of verifiable proof. Like how many accidents, how much data, and so on, and the human aspect of how I feel when I'm in this car, what it tells me, et cetera. And so that's why I think some of the like Some of these some of our AI tools tend to, imbue me with more of that feeling of trust, even if the data says this is 100% accurate. I feel like it takes more time for us to go, “Should I trust this or not?” And that's in the soft sense of, startups with high agency, weekend projects, and open source. And then there's enterprises and regulated industries and everything else, and that is an even harder problem to go solve because even when it is fully verified, not only do you have to have trust from the humans on the team, you probably have to have trust from multinational,Swyx [00:37:55]: Oh my GodKyle [00:37:55]: Multi governments around the world and regulating agencies. And so that's where I feel like until we tip over to your point on the sort of like human EQ side of it. I feel okay this feels okay I've been proven enough. Then the ball will start to roll a lot faster, where we'll end up getting to the “Okay, we can trust this,” and feel good about it in the Most difficult of cases.Reputation, Sponsors, Stars, and Bot Activity on GitHubSwyx [00:38:18]: If human trust is the thing that matters, I feel like GitHub as the developer social network could maybe do more there. Like vouchers are one system But, we have star counts, and then we have Contributor rights, and that's it. And I feel like there should be more in that space. I don't know if there's any other design decisions there.Kyle [00:38:37]: I think that one of the places that we don't really expose right now in this sort of way is, some degree of like hard trust and support, which would like for me is like sponsors is a good example of that.Swyx [00:38:49]: Ah.Kyle [00:38:49]: It like costs you something. To prove that I believe in your project and I trust you To some degree or I want to support you at the very least.Swyx [00:38:56]: Solve payments for open source. Why not?Kyle [00:38:58]: I think that I think that like as we keep moving forward, right, there's more and more projects where I'm, adding more and more dollars into sponsors personally because I want to like support them, but I also like know of I've probably never met them in person, but, I know of enough of their work that I want to support them. I think the thing that I don't love about stars or commit counts or anything else is ultimately, even with all of the various, abuse and de-spamming and deduplication work that we do or anti-abuse work that we do, these are all, not active social signals. They're passive ones that are ultimately gamifiable. And you may trust me, but another open source maintainer may not. And on what heuristic should you be, trusting me? That I think, is kind of where some of our thinking is right now. What signal from me is most important to you? You— If you can define that potentially, honestly in an agentic workflow that's what we see some of these open source projects do, where you have GitHub actions, and then you have like an agentic workflow that's calling AI, and you're setting these rules. Like if Kyle has submitted and gotten accepted PRs across any given project and has a social handle tied to his account in GitHub, and that social account's older than a certain amount. Really complex measures that matter to you ‘cause most open source projects have that heuristic built into their heads, if not written down in the contributing guidelines. You could take that and then go apply that and then just say, “Oh, we're not going to accept this PR.” Building something that is, I think, malleable to everyone's needs, is a little bit better, rather than going “Hmm, this account's too young.” Because what happens? The attackers just go and go and create a multitude of accounts, and they wait Until it ages up. Needs to have a certain amount of stars. That's how star inflation happens. Need to have a certain amount of reposSwyx [00:40:46]: Oh my God. YeahKyle [00:40:47]: With PRs. They all just create repos and submit PRs to each other, and then they come in and do something nefarious. And so, it's hard. It's hard to find the measure. So I think we're, we're looking more at how can we provide you tools so you can kind of choose what's best for you. And of course, we'll give you some standards. But the trust vector, gets down to I don't know, some version of like human digital ID like everyone's been talking about. Like how do I prove that it's meSwyx [00:41:13]: Give me your eyeballsKyle [00:41:14]: On the internet. Give me your eyeballs. Exactly.Swyx [00:41:18]: The I got to keep moving on Topics, but obviously I can go all day on this stuff because, I've been involved in GitHub and open source My entire professional career. Stars. Very superficial. Everyone knows it. But I think time to one hundred thousand stars is the fastest I've ever seen. Like people just reached that in I don't know, months. And then like at the same time I don't trust it right? Like how many of these are real or bot or like whatever. I don't know how to ask this but like what can we do about it? LikeKyle [00:41:49]: JustSwyx [00:41:49]: Is stars broken? Is stars fine?Kyle [00:41:51]: I think that there's kind of two, there's like two pieces. Obviously we're constantly like trying to find ways in which like your users are producing spam, which would, I would include like be like only doing star gamification. When we find them, we pluck ‘em out and we,Swyx [00:42:08]: But it's like a Whac-A-MoleKyle [00:42:10]: It's a hundred percent like a Whac-A-MoleSwyx [00:42:11]: There's no wayKyle [00:42:11]: Now, powered by AI to be helpful. But I think more so what I'm seeing is, a lot of the like fastest time to X tends to be because we're now inviting so many more people into like software development on GitHub That like the zeitgeist is just swarming? And it'sSwyx [00:42:32]: It's not just developers anymoreKyle [00:42:33]: And it's not you and I. Like like however you want to say like what a developer is it's not just folks who have been coding for a very long time. It's folks that have maybe started coding or only joined in since the AI era. And nowSwyx [00:42:44]: what's the latest Octoverse number? I know eighty million was my lastRem- member that a number of developers on GitHubKyle [00:42:50]: Oh, we're over 200 million now.Swyx [00:42:53]: Okay. Well, so you see?Kyle [00:42:55]: Like over 200 million developers now.Swyx [00:42:56]: But it's not developers, right? It's, it's people with a GitHub account.What Counts as a Developer in the AI Era?Kyle [00:43:00]: So, so this is, this is the biggest debate that I would say, everyone loves to have at GitHub at this point. From my perspective, right, I think that there's, there's clearly a difference between, professional enterprise developer and then developers. But I think that I think that the idea that we should be I don't know, splitting hairs or segmenting developers in the early era of software development is, not worth our not worth the time. SoSwyx [00:43:29]: When you get into gatekeepingKyle [00:43:31]: 100%Swyx [00:43:31]: What is a developer?Kyle [00:43:31]: 100%. ‘Cause I wasn't a developer when I started writing code? I was going toSwyx [00:43:36]: Oh, no. I made— I cloned a thing, seven years before I learned to code. And then I and then I wrote about my learning to code journey, and people Just called me a fraud ‘cause I had a GitHub account. And I'm “Well, no, I just use GitHub, but I don't know-” “I didn't know what I was doing.”Kyle [00:43:49]: I I remember that. I remember those sets of posts, and like that's, that's b******t. So I fight very clearly on the line of, if you create code, if you have an idea and you create it into some way of, I'm, I'm going to run it and use the app right now, you may still use AI in that moment, but that's okay. At some point you're going to do the next thing. You're going to create a big— You're going to have to learn about this database. You're going to fix a bug, whatever. We're all on some same journey, and those people are also hearing about the great new agent skill package or a new CLI tool or a new whatever. And those projects are going up because you want to be a part of this moment, just like I wanted to be a part of the Ruby community when Ruby was popping off when I started becoming a developer, and now I can just click the star button. And so I think that yes, there's clearly some amount of like spamming and game gamification that we're working against, but I really think we're just seeing this whole new cohort of folks that are moving from technology to technology because they're not working on a 20-year-old software application. They're working on a side app that they built on the weekend for their friends or for their new idea or whatever. And that's how you see these enormous charts going up and to the right with With stars.Swyx [00:44:59]: I think something that's remarkable is the persistence or, that GitHub extends to those folks. Usually when I see platforms go into a new audience, they usually have to, have like a second platform with a different name that wraps the main platform. But somehow GitHub has been able to sort of persist and extend, and it's friendly and whatever? So it's, it's nice.Spark, Low-Code, and Always Showing the CodeKyle [00:45:19]: I that's partially why I think as we've tried to move into I don't know, more like low-code-y things. We so we started working on Spark as like a way to, build an app and run it. I think that the reality is that we anytime we try to, kind of put even a veneer on top of it without when we put a veneer on top of something, we still always show you the code. That's kind of like a tenant. We're never going to, hide the code from you ever, because whatSwyx [00:45:52]: Why would you?Kyle [00:45:52]: That's, yeah, that's the whole point? However, I think that what we learned with things like Spark is that really the value of Spark for most devs is, easy runtime. And you may have a runtime or a host that you're going to use for that or you just build something and run it but, the package of making that even more simple isn't really needed for folks that are trying to build software and not just trying to build, an app, which is, slightly different, a slightly different goal. So I want to get you in, I want to get you comfortable. I think the best thing for me as, someone that did not traditionally come into software dev way back, I want anyone to be able to breach that chasm and not be in the I don't know, I feel like we're, we're still in an era of, STEM. I've got a 12-year-old and an eight-year-old, and it's “We got to get ‘em into STEM,”? Over and over. And I like I do, I do the things that good parents do. I was “Oh, you want to do coding?” “Yes, I want to do coding.” Do coding classes. But now they're just not afraid of doing software. And that's, I think, the thing that's honestly kept me at GitHub for so long. Anyone should be able to go and build a thing, just like I can go change a light switch in my house. I'm not going to go into the breaker box ‘cause I'll probably kill myself? But, I can go change that light switch. Everyone should be able to go and say, “This fricking app doesn't do what I want. I want it to work like this.” And that I think, is what's kind of kept us all connected with GitHub through the years and some and during the easiest of times or in the hard times because of that opportunity of, we're the home for all developers, and we want everyone to be able to have that feeling that we've had of, had an idea, I created it and holy s**t here it is.Swyx [00:47:37]: Here it is. All right, I'm going to try to do more spicy questions.GitHub's Hardest Scaling Moment: Growth, Agents, and UptimeKyle [00:47:42]: Great.Swyx [00:47:42]: Is it an easy time now or a hard time?Kyle [00:47:45]: Oh at GitHub? It's a hard time. Like, it's a hard time and also, I was just with my team and I said, “This is also, the best and most exciting time that I think I can remember at GitHub.” BecauseSwyx [00:47:57]: Best of times, worst of times. It's never oneKyle [00:47:59]: ‘cause we've we were talking about Octoverse reports and, usually we do an Octoverse report once a year, and we look at the numbers, and we say, “Oh my goodness.” I was at Universe in October saying, “This was the fastest year of growth that we've ever had,” right? And now we're doing more in a month than we did in a year last year.Swyx [00:48:20]: You're talking about PRs.Kyle [00:48:21]: Commits.Swyx [00:48:21]: Commits, yeah.Kyle [00:48:22]: PRs. Kind of like you name it by roughly every measure that we're looking at, there's some amount of sort of growth that is much bigger, and that is breaking our system in new ways, not old ways. Like webhooks were always notoriously, unreliable over the years?Swyx [00:48:38]: Whose fault is that?Kyle [00:48:39]: not anymore mine, but for a period of time, I'm sure you could pull up a tweet that was “It was me. I'm sorry.” but, now, that got rewritten at a scale level that is still working and is not having problems today. Now what we're finding isn't just the isn't the-The simple stuff that folks are on the sometimes on Twitter or on the internet are “Hey, why is this like this?” Sure. There's absolutely silly problems that we shouldn't exist. But now we're talking about, unique, novel permission problems that happen only at a scale across all different objects or whatever, that now we have to go rewrite this underlying system. And so it's, there are problems that yeah, caught us off guard, which I think I said. Like the growth is astronomical, but also we're making such material progress in that I'm excited once we're once we've kind of like reimagined the underlying foundation layer, or pieces of it at least, what's going to be possible when it's not just all of us and all the new people that are being developers and all of their agents and all the tools like working together. Because that'll still happen in that in that GitHub tool, that GitHub community. But it's a it's a hard day anytime we can't give you what you're looking for. We have the same problem internally. We operate through github. Com. Of course, we have backups when things go down and whatnot for our own operations but we feel it too. If it's not working it's not working for us, and that's kind of like the promise of dogfooding for GitHub. It's always been true. We're using the same tool you're using. We're not using a super secret version. We and so we also need it to be great for us for our customers of course for open source. And now an exponential growth of agents, Doing it too.Swyx [00:50:32]: I wanted to load for audio listeners who maybe haven't seen your tweets, whatever. So one billion commits in twenty-five. Now it's two hundred and seventy-five million per week on pace for fourteen billion this year, if growth remains linear. Is that still the pace? I don't know. It's been aKyle [00:50:48]: it's, it's speedingSwyx [00:50:50]: Roughly.Kyle [00:50:50]: It's still speeding up.Swyx [00:50:51]: It's, it's April, so yeah.Kyle [00:50:51]: Exactly. This was in April.Swyx [00:50:53]: All right. So basically you have fourteen x growth, right? Year on year on year. And I think that's a scaling issue. I think, I'm going to like try to really steel man this thing. People have experienced fourteen x growth. They haven't had your downtime. And that's like— C-can we go dig into that? Why? Like what's the— what broke? What are we doing to fix it? Like just anything for the community to reassure them.Why GitHub Reliability Is Breaking in New WaysKyle [00:51:18]: so there's a Like I was saying, there's a couple different places that we've seen the growth issues. Some of the growth issues, which is why we're t— I was talking about pushing hard on more CPUs is in actions in particular. More tools, more agents, more PRs mean more builds, more builds mean more CPUs. And so we are expanding through not just our data center, but obviously we were talking about moving to Azure and moving to, adding an additional cloud compute because we simply need more CPUs. Not as much GPUs. We definitely need GPUs too, but now CPUs are becoming a factor.Swyx [00:51:53]: It's very CPU heavy.Kyle [00:51:54]: Underneath the hood when it comes to some of the underlying services, we've been breaking up over the years our database infrastructure, so that way we have, more cognitive separation between our the various services. The place that we continue to have pain is in, permissioning. And so right now m-many of our permissioning layers sit into a database that we like internally call MySQL One, and old Hubbers will know what I'm talking about. And so we've been pulling things out of MySQL One for many years, because like and we use we use Vitess and we use other technologies to shard and we do it as one bigSwyx [00:52:31]: Famous thing, PlanetScale was born from this andKyle [00:52:32]: A hundred percent. Sam Old Hubber and friend. And so finding these opportunities to like break this out and then do that globally. The other thing that I think is interesting and both a unique opportunity and tricky is we also run everything I just talked about in a black box container with GitHub Enterprise Server for people that work on-prem. So we take everything I just said, and we also do it on-prem, and we also do all of that and we do it in a data residence setup for customers that need to have their data in a single location. Each of these has the unique characteristic around how we're sort of storing that data in MySQL or in a permissioning setup. That's where some of these outages have oc-occurred, where you're seeing it more like across the board rather than just like the one pieceSwyx [00:53:17]: Filling the databaseKyle [00:53:17]: Isn't quite working. Exactly. And so part of it is that. I think there's been some other places where agents are much more or more projects appear to be moving towards monorepo versus we were going the other direction for many years in the industry. Repos were smaller, but there were more of them, and now we're seeing the opposite. Repos are bigger, and there's, not fewer of them per se ‘cause there's new growth, but, we're just seeing many more big repos. Big repos, big monorepos have always had, a unique performance problem. Because each one, is slightly different if, particularly if the underlying blobs are incredibly big Inside the repos. And so we've done a ton of work that you pro— like most people haven't probably experienced, unless you're in this case of the monorepo. But that Git, infrastructure layer improvement does help the overall, system because, many of the improvements that make monorepos work better make all repo infrastructure work better. And so, I could kind of keep going down the line where it's another thing where we're moving out of, We're changing how we do j I'll just say job queuing for lack of a better, explanation changing the underlying technologies there.Swyx [00:54:32]: I spent two years being a job queuing guy, so.Kyle [00:54:34]: And so it's kind of a little bit of a little bit of piece by piece, and it's mostly because as we were— as it was built, we built everything in a way that assumed, I guess in some ways that the size of the pipe of work was going to remain the same. There's just going to be more people coming through each of those pipes. But instead now in places whereA git push was, generally a certain size for example, is now, no longer true.Swyx [00:55:03]: Oh, yeah.Kyle [00:55:03]: OrSwyx [00:55:05]: I push a thousandKyle [00:55:06]: On the average. 100%Swyx [00:55:06]: A thousand line commits like dailyKyle [00:55:07]: Same thing with PRs. Like PRs same thing. And like we've talked about optimizing that and making changes where, and there were technology choices that did not work there? And it got slow, and it didn't It was not fast. It did not do what the users wanted. And so we've been reeling that all out and going “Okay, that's just not right. Let's stop putting good money after bad and do it the do it the right way or the right way now.” So there's It's a it's a lot of things, not quite when I've experienced scale at GitHub historically, it's almost always two options that we've used. We go vertical scaling, particularly with databases, right? And we go horizontal scaling. Oh, we just have more people using this service. Great. We're going to add more servers, and we rack them in our data center, or we use it in a cloud. And now we're sort of in a like diagonal, where like vertical doesn't really work anymore. Horizontal isn't work either because we're all We all have some CPU or GPU constraints in the world now, and now we have to go in and like crack open services that have been running for 10 or 15 years and go, “Okay, the rules of this service have legitimately changed, and now we have to rewrite them.” None of this is an excuse. This is like we're We have to do the work. We have to make it better.Swyx [00:56:22]: actually as an infra guy, I'm “This is like one of the most fascinating scaling challenges I've ever seen.”Kyle [00:56:26]: That's that's, that's the thing that's the thing that it's hard for Like when we weren't talking about it publicly, and I was like I came out, and I was “Hey, I just want to explain what's going on.” Part of it comes from a very old GitHub ethos, which is it's our it's our uptime. It's down. W What I know you're a developer, so you're, you're inclined to want to understand more what's going on. But at the same time us going “Hey, this service didn't, perform the way we expected, and now we have to go change it,” we weren't We're not trying to hide anything from you i

864 They Will Heed Your Voice, A Guided Christian Meditation on Exodus 3:16-19 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable to do so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation Exodus 3 NKJV 16 Go and gather the elders of Israel together, and say to them, 'The Lord God of your fathers, the God of Abraham, of Isaac, and of Jacob, appeared to me, saying, "I have surely visited you and seen what is done to you in Egypt; 17 and I have said I will bring you up out of the affliction of Egypt to the land of the Canaanites and the Hittites and the Amorites and the Perizzites and the Hivites and the Jebusites, to a land flowing with milk and honey." ' 18 Then they will heed your voice; and you shall come, you and the elders of Israel, to the king of Egypt; and you shall say to him, 'The Lord God of the Hebrews has met with us; and now, please, let us go three days' journey into the wilderness, that we may sacrifice to the Lord our God.' 19 But I am sure that the king of Egypt will not let you go, no, not even by a mighty hand. 2 RSV 16 Go and gather the elders of Israel together, and say to them, 'The Lord, the God of your fathers, the God of Abraham, of Isaac, and of Jacob, has appeared to me, saying, "I have observed you and what has been done to you in Egypt; 17 and I promise that I will bring you up out of the affliction of Egypt, to the land of the Canaanites, the Hittites, the Amorites, the Per′izzites, the Hivites, and the Jeb′usites, a land flowing with milk and honey."' 18 And they will hearken to your voice; and you and the elders of Israel shall go to the king of Egypt and say to him, 'The Lord, the God of the Hebrews, has met with us; and now, we pray you, let us go a three days' journey into the wilderness, that we may sacrifice to the Lord our God.' 19 I know that the king of Egypt will not let you go unless compelled by a mighty hand. Reflection on Scripture: God called Moses to listen to the voice of a burning bush in the wilderness and from the beginning God told him that the people would accept him and that the Pharaoh would not. God knew with precision what would be required to deliver His people from bondage and He told Moses all about it. This was an unknown blessing. Moses did not understand the blessing that he was given. He was given the answer for how it would pan out. Many times in our lives we take steps into what seems to be darkness to our eyes. There have been many times in my life and my ministry where I feel I have gotten only a small partial direction without any indication of what would happen. In fact my whole journey to become a Chaplain took me a total of 8 years and I had no assurance that my path would end in success as it has.  Invariably I suspect for most things God directs us to do we will not get clear direction on the outcome. DIcernment in and of itself is a valuable thing. After we are reasonably assured we have been given a direction the battle is not over. We have to just roger up and do the best we can and stay open to further guidance God gives us along the way. Moses was told the people would listen and that Pharaoh would only respond when compelled but many times Moses didn't know what was coming next.  God invites us into a relationship of trust. He had no such relationship with king of Epypt. So in this situation although it would be very challenging to be Moses, it would be far worse to be the king who opposed him, who opposed God. So the invitation stands to each of us. Do we respond to the call of the Lord or do we choose what our human passions desire? Do we bravely wade into the deep waters, sustained by a God of wonders or do we cower in fear hiding from the Lord? I know what I want that answer to be for me, what is left is actually doing it.  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod

862 I AM THAT I AM, A Guided Christian Meditation on Exodus 3:13-15 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable to do so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation Exodus 3 KJV 13 And Moses said unto God, Behold, when I come unto the children of Israel, and shall say unto them, The God of your fathers hath sent me unto you; and they shall say to me, What is his name? what shall I say unto them? 14 And God said unto Moses, I Am That I Am: and he said, Thus shalt thou say unto the children of Israel, I Am hath sent me unto you. 15 And God said moreover unto Moses, Thus shalt thou say unto the children of Israel, the Lord God of your fathers, the God of Abraham, the God of Isaac, and the God of Jacob, hath sent me unto you: this is my name for ever, and this is my memorial unto all generations. ESV 3 Then Moses said to God, "If I come to the people of Israel and say to them, 'The God of your fathers has sent me to you,' and they ask me, 'What is his name?' what shall I say to them?" 14 God said to Moses, "I am who I am." And he said, "Say this to the people of Israel: 'I am has sent me to you.'" 15 God also said to Moses, "Say this to the people of Israel: 'The Lord, the God of your fathers, the God of Abraham, the God of Isaac, and the God of Jacob, has sent me to you.' This is my name forever, and thus I am to be remembered throughout all generations. Reflection on Scripture: It is difficult even to know exactly which way to go when thinking through this passage. It is heavy and simple at the same time. Moses had a legitimate problem. He didn't even know how to refer to God. He did not know God's name. He presented it as a tactical problem. How could he preach belief in a God without a full understanding of who God is. The simplicity and complexity is that God's response is not specific. On the one hand it represents an actual thing Moses could pass on as a solution for this question but on the other it is not a formal name. In fact it is much deeper. It is the essence of being.  In greek the phrase would have been written as Ego Eimi which is just I am or I exist. It is the essence of being. And also it is declarative. In contrast with the human notion of existing that we exist because we can do or think. God exists because he exists. We come into existence by God's hand in creation, and He exists. There is not criteria for proof given in this declaration, just the certainty of His eternal existence.  This became such a profound statement from God such that when Jesus later said in the book of John "Before Abraham was, I AM" the people instantly grabbed rocks to stone him for blasphemy. He equated Himself to be the one who spoke to Moses in this experience with the Burning Bush. The most important statement God wanted to make to the people is. I am here, and I am me. And that is the declarative statement that should be rend us to our soul. God exists. God is here. He is who He is and it is our great blessing to slowly gain understanding of what that means for the rest of our lives and into eternity.   Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod  

860 Who Am I That I Should Go, A Guided Christian Meditation on Exodus 3:10-12 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable to do so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation Exodus 3 NIV 10 So now, go. I am sending you to Pharaoh to bring my people the Israelites out of Egypt." 11 But Moses said to God, "Who am I that I should go to Pharaoh and bring the Israelites out of Egypt?" 12 And God said, "I will be with you. And this will be the sign to you that it is I who have sent you: When you have brought the people out of Egypt, you will worship God on this mountain." RSV 10 Come, I will send you to Pharaoh that you may bring forth my people, the sons of Israel, out of Egypt." 11 But Moses said to God, "Who am I that I should go to Pharaoh, and bring the sons of Israel out of Egypt?" 12 He said, "But I will be with you; and this shall be the sign for you, that I have sent you: when you have brought forth the people out of Egypt, you shall serve God upon this mountain." Reflection on Scripture: Moses felt genuine and well placed self doubt. He knew that his own influence would not be enough to do what was in front of him. He knew that Pharaoh would not listen to him and do what he was being asked to do. He was quite literally being asked to do something that is impossible. Pumping himself up to believe he could do the impossible would be pointless. Sometimes in this world we get the message that all we have to do is manifest things by believing in them and that makes them come true. God invited Moses into something else. He said "I will be with you". It is the presence of the Lord that makes impossible things possible. When you encounter some massive issue in your life it doesn't even matter if you can even overcome the issue yourself. The message here though is that with God it is possible. When you feel overpowered, turn your confidence to the all powerful God of heaven.  The sign that God gives is that Moses will serve Him on the mountain. The answer to what is impossible is not your strength or wisdom, or anything else you do. Your talents do matter but they are not what make the real difference. The life saving difference. Let God prevail in your life. This meditation is your weekly reminder to put your confidence in your God. When your power fails, that does not mean that all power fails.  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod  

858 I Have Heard Them Cry Out, A Guided Christian Meditation on Exodus 3:7-9 with the Recenter With Christ app The purpose of this podcast is to help you find more peace in  and connect with the true source of peace, Jesus Christ.  Outline: Relaxation, Reading, Meditation, Prayer, Contemplation and Visualization.  You can sit comfortably and uninterrupted for about 20 minutes.You should hopefully not be driving or anything tense or unrelaxing.  If you feel comfortable to do so, I invite you to close your eyes.   Guided Relaxation / Guided Meditation:   Breathe and direct your thoughts to connecting with God. Let your stomach be a balloon inflate,  deflate. Scripture for Meditation Exodus 3 NIV The Lord said, "I have indeed seen the misery of my people in Egypt. I have heard them crying out because of their slave drivers, and I am concerned about their suffering. 8 So I have come down to rescue them from the hand of the Egyptians and to bring them up out of that land into a good and spacious land, a land flowing with milk and honey—the home of the Canaanites, Hittites, Amorites, Perizzites, Hivites and Jebusites. 9 And now the cry of the Israelites has reached me, and I have seen the way the Egyptians are oppressing them. NLT 7 Then the Lord told him, "I have certainly seen the oppression of my people in Egypt. I have heard their cries of distress because of their harsh slave drivers. Yes, I am aware of their suffering. 8 So I have come down to rescue them from the power of the Egyptians and lead them out of Egypt into their own fertile and spacious land. It is a land flowing with milk and honey—the land where the Canaanites, Hittites, Amorites, Perizzites, Hivites, and Jebusites now live. 9 Look! The cry of the people of Israel has reached me, and I have seen how harshly the Egyptians abuse them. Reflection on Scripture: I want you to stop everything you are thinking and hone in on this call from the Lord. I am aware of your suffering is what he says to you. I know what you have been through. This scripture points out that he could tell you clearly, I know your victories and your setbacks. I know your heart. I know what you need. I know what it takes to craft you into the image I want from you. Not only do I know all these things but I am strong. I am strong enough to save you. I have that power. The greatest challenge of all the one we should be most desperate for is a forgiveness of our sin.  Each one of us has weakness within our mind and heart. Take this moment to turn from that weakness toward the strength God offers. Working with people in the most challenging of circumstances has shown me again and again that each of us have our own story with plenty of deep valleys. As an example It has been a few weeks since I put out an episode. I got sick then had a family member in the hospital and then someone I minister to in a professional context was in the hospital. So I have had many things up in the air. And at the end of all that I ended up traveling to support a family member and I am not at home to celebrate Mother's Day with my wife. At certain points I have been quite low recently. And yet I know that my struggle is knot unknown to God. He knows it. And he lets these things happen because he knows what is required to cause us to grow. He knows what is required for us to overcome. Please trust the one who has power to save.  Meditation of Prayer: Pray as directed by the Spirit. Dedicate these moments to the patient waiting, when you feel ready ask God for understanding you desire from Him. Meditation of God and His Glory / Hesychasm: I invite you to sit in silence feeling patient for your own faults and trials. Summarize what insights you have gained during this meditation and meditate and visualize positive change in your life: This is a listener funded podcast at patreon.com/christianmeditationpodcast Final Question: If you consider the invitation and command to persevere in the faith, what change in your life does that bring to your mind?  FIND ME ON: Download my free app: Recenter with Christ Website - ChristianMeditationPodcast.com Voicemail - (602) 888-3795 Email: jared@christianmeditationpodcast.com Apple Podcasts - Christian Meditation Podcast Facebook.com/christianmeditationpodcast Youtube.com/christianmeditaitonpodcast Twitter - @ChristianMedPod