Podcasts about svc

Alain Grossenbacher ist im unteren Emmental aufgewachsen und studierte Betriebsökomie. Niemals hätte er gedacht, einmal ein Bauunternehmen in Obwalden zu führen. Wie es dazu gekommen ist, erzählt CEO und Inhaber der Eberli AG, Alain Grossenbacher Moderator Oliver Steffen in der neuesten Folge des Podcasts «KMUStorys» des Swiss Venture Club (SVC).   Die Liebe zu einer Innerschweizerin hat Alain Grossenbacher nach Luzern gebracht. Dort lies er sich zum Wirtschaftsprüfer weiterbilden. Diese Aufgabe brachte ihn zur Eberli AG, wo er später als FInanzchef eingestellt wurde. Gut fünf Jahre danach stieg Alain Grossenbacher zum CEO auf. Die Eberli AG ist in der Zentralschweiz tätig und hat unter anderem das Stadion des FC Luzern und das Athletik- und Ausbildungszentrum des EV Zug gebaut und ist jetzt am Handballstadion des HC Kriens-Luzern. Auch Hotelprojekte hat die Eberli AG schon viele umgesetzt. Einmal war es dabei in Engelberg fast zum Abbruch des Projektes gekommen. Die Bauarbeiter seien kurz vor Weihnachten wegen grossen Grundwasserproblemen in FIscherstiefeln in fünf Grad kaltem Wasser gestanden. Das sei grenzwertig gewesen, beklagte ein Bauführer. Wie es sich dann angefühlt hat, als das Projekt trotzdem fertiggestllt wurde, erzählt Alain Grossenbacher Moderator Oliver Steffen in der 44. Folge des Podcasts KMUStorys. Der rund 30-minütige Podcast «KMUStorys» des Swiss Venture Club (SVC) ist über alle gängigen Podcast-Apps wie Apple Podcasts, Spotify, TuneIn oder Google Podcasts erhältlich. Zudem ist er über die Website des SVC sowie auf den Radioseiten von CH Media verfügbar. Oliver Steffen beleuchtet im Gespräch mit KMU-Persönlichkeiten die grossen Geschichten hinter den kleinen und mittleren Unternehmen der Schweiz.

For the first time ever, AfterThinkers join the podcast LIVE from SXSW in Austin, Texas. In partnership with SVC, the guys are joined by comedians Donald Gee and Andrew Stanley to talk about the challenges of clean comedy, Doug cussing on stage, and Ethan giving Andrew's dad a new fear for his life. All filmed in front of a live studio audience.

Late last week, U.S. Securities and Exchange Commission chair Gary Gensler said that he was “proud to serve” the agency, which some are taking as a hint at an upcoming resignation. Gensler has faced heavy criticism for his crackdown on crypto, including a recent lawsuit from 18 states, and is likely to be replaced under President-Elect Donald Trump who has vowed to oust Gensler. On Tuesday, the Wall Street Journal reported that Trump is meeting with Brian Armstrong, the CEO of crypto exchange Coinbase, to discuss potential personnel appointments. Today on Equity, we're bringing you an interview between Rebecca Bellan and co-founder and CSO of  blockchain analysis firm Chainalysis, Jonathan Levin. The pair caught up at our Strictly VC event in New York shortly before the Gary Gensler news dropped to discuss: The imminent change for crypto in the wake of the US election Trends in crypto crimeChainalysis's choice to run its operations in the US How to build trust in cryptoEquity is TechCrunch's flagship podcast, produced by Theresa Loconsolo, and posts every Wednesday and Friday. Subscribe to us on Apple Podcasts, Overcast, Spotify and all the casts. You also can follow Equity on X and Threads, at @EquityPod. For the full episode transcript, for those who prefer reading over listening, check out our full archive of episodes over at Simplecast.  Credits: Equity is produced by Theresa Loconsolo with editing by Kell. Bryce Durbin is our Illustrator. We'd also like to thank the audience development team and Henry Pickavet, who manages TechCrunch audio products.

On this episode I talk with Eric Kellegrew, Stewardship Director of the Sacramento Valley Conservancy, to walk through the task and effort of developing a well and water trough system at the 4,600-acre Deer Creek Hills Preserve, located in east Sacramento County. A superficially unassuming and honestly uninteresting accomplishment, that is, without context. It turns out this inconspicuous water source provides the means and adds significant capacity to better manage thousands of acres of rangelands, improving cattle management by better dispersing grazing pressure, supplying water for restoration and replanting efforts, and providing a perennial water source for wildlife on an otherwise parched landscape through the summer and fall months. In my opinion this project perfectly embodies the nature of stewardship work. You identify a problem, you use what you got to find a solution, and it takes a long time, but it's worth it. We really get into the weeds on this one, dissecting the behind-the-scenes work that often goes unrecognized. Hope you enjoy. For more information on events and ways you can experience the lands protected by SVC click here.  

Let us know what you think - text the show!On this week's show:Happy National Coloring Book dayGlo's skunk updateWhoop there it is / who let the dogs outWhy does Vermont keep flooding? Cheif Murad doesn't like repeat offendersBurlington rugby star Ilona Maher wins Olympic bronze Vote for the ghost of Dick Sears Accidental Covid-19 case dismissedTraffic-calming devices installed on busy Burlington street New UVM surgical office approvedVermont in top 10 states with most federal disaster declarations (1:01:23) Break music: Suburban Samurai - "Zombie" https://suburbansamuraimusic.bandcamp.com/track/zombie  Sage Farm Goat Dairy wins national award South Burlington City Council bounces pickleball solutions Brazen bears rattle Stowe Giant pinecone-like egg statue coming to new Williston art park Resort planned for former SVC campus 'advancing'Dog Mountain cancels summer festival(1:41:10)  Break music: Violet Crimes - "Some Exceptions May Apply" https://violetcrimesvt.bandcamp.com/track/some-exceptions-may-apply Scumbag Map  Driver intentionally drives wrong wayImpressive shoplifting in Bellows Falls & Brattleboro Brandon teen charged with sex assaultWaterbury man arrested for Morristown murderMontpelier bat attack 77-year-old Bennington woman charged with trying to grab gun from police officer 18-year-old arraigned on felony charges after violent attacks in BenningtonSpringfield man faces multiple drug chargesChinese turtle smuggler convictedThanks for listening!Follow us on Facebook: facebook.com/VermontCatchup Follow Matt on twitter: @MatthewBorden4 Contact the show: 24theroadshow@gmail.comOutro Music by B-Complex

This episode is all about food that makes you happy and the wines that we enjoy drinking with them. SVC + JTM hit up the Livermore Valley Interwinery Tasting to check out the 2024 vintage here in the region. We recap wines and people to be excited about, wines of the night, the biggest surprises, and more. JTM then surprises SVC to pair the best wines from the tasting with a few of her favorite Livermore Valley eateries. Tune in for all the latest Livermore Valley Wine Country news and happenings. Be sure to subscribe and join the Tri-Valley's first and only hospitality podcast. #eatlocal #drinklocal #livelocal

The church is the people, and today, we celebrate the incredible dedication and love of everyone who has served at SVC this year. We honour everyone who has helped create space for Jesus to be worshipped and his table extended to the least, the lost, the near, and the far-off. Thank you all!

Spoiler Alert - If you have not completed The Bear season 3, consider this your warning. In this episode, Jeremy Troupe-Masi & Savannah Vento-Chun review the highly acclaimed and Emmy award-winning show 'The Bear'. SVC & JTM challenge various reviews while also offering a few of their own and ultimately answer the question. Did season 3 live up to the hype!? Tune in now and find out for yourself. If you enjoyed this episode be sure to subscribe and stay up to date with our weekly releases. Next week's episode covers the 2024 Livermore Valley Wine Country Vintage Review.

This week's episode will be focusing on common topics both for new fellows & residents. We will go over the important details on some clinically important oncologic emergencies including brain metastases, hypercalcemia, cord compression and SVC syndrome. 

An exciting new academic year is about to begin. We know this can be daunting, especially for our newest hematology/oncology fellows. Over the next two weeks, we re-boot some of our high yield episodes you need to know to prepare for your first days as a new fellow and your nights on call. Next up: Superior vena cava (SVC) syndrome ! [Originally episode 012]- What is the workup?- What is the differential diagnosis? - What do we do once we get the phone call about this emergency? - Who should we be consulting?** Be sure to check out our rotation guide for more show notes and episodes organized by disease type: https://www.thefellowoncall.com/rotation-guides** Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

Join JTM & SVC for another TTG Short. This new segment allows us to experiment with some creative writing and offerings. In this segment, SVC takes the lead and shares why our Livermore Valley Farmers Market is more than meets the eye. And to her, why the Farmers Market serves as the center of community. We hope that you continue to enjoy these, share our podcast dang it and give us a follow!

Come hang out with JTM and SVC as we continue digging into a new segment called TTG Shorts. This series will take you through fun and meaningful reviews of your favorite local businesses. In this episode, JTM takes a heartfelt moment to reflect on the impact that the late Anthony Bourdain has made not only on the industry but also on JTM. We hope you enjoy these new segments. Let us know how you like them and leave us a review! Hit that subscribe button and stay tuned on all TTG happenings.

,,,We are back after a few weeks away from the microphones. While we were away though, Advanced Creative saw an expansion, doubling in size and offering TTG a brand-new recording studio. This is the first time in a several episodes hosts SVC, JTM , & Matt were able to record together as well. We spend much of our discussion catching up, sharing some summer happenings and find ourselves missing home.

Petra Joerg ist CEO von Rochester-Bern. Einer «kleinen Boutique Business School», wie sie selbst sagt. Wo sie Parallelen zwischen ihrem Job und ihrer anderen Leidenschaft, dem Bergsteigen, sieht, erzählt Petra Joerg Moderator Nik Hartmann in der neusten Folge des Podcasts «KMUStorys» des Swiss Venture Club (SVC). Sie mochte die Berge schon immer. Erst mit 50 Jahren wollte Petra Joerg sie auch erklimmen. «Es war Sommer, es regnete und ich war erkältet». Es musste etwas Neues in mein Leben kommen, dachte sich Petra Joerg vor etwa zehn Jahren. Als sie wieder gesund war, fuhr sie spontan nach Saas-Fee, mit dem Ziel, das über 4000 Meter hohe Allalinhorn zu erklimmen. «Ich wollte gleich richtig damit anfangen» Bei der Abfahrt mit den Skiern riss sich Petra Joerg dann jedoch das Kreuzband. Gurt, Helm und Kletterschuhe mussten wieder in den Schrank. Das Comeback liess aber nicht lange auf sich warten: «Ich sagte dem Chirurgen, ich will Ende Jahr wieder in die Berge», so die klare Forderung, die in Erfüllung ging. Weniger klar ist Petra Joergs Berufsweg. «Ich machte eine Lehre als Arztgehilfin, weil ich Ärztin werden wollte. Ich machte eine Lehre in einem Hotel, die Hotelhandelsschule, und studierte später auch noch.» «Alles, was man im Leben gemacht hat, nützt einem irgendwann» Dass sie einmal CEO werden würde, hätte Petra Joerg nie gedacht. «Ich mag Menschen und ich bin neugierig und wenn mir jemand eine Chance anbietet, sage ich nicht nein». Und so wurde Petra Joerg nach ihrem Wirtschaftsstudium, und nachdem sie als Journalistin arbeitete, CEO von Rochester-Bern Executive Programs. Worauf Rochester-Bern bei der Ausbildung von Führungskräften besonderen Wert legt, erzählt Petra Joerg im Gespräch mit Moderator Nik Hartmann in der 35. Folge des Podcasts KMUStorys. Der rund 30-minütige Podcast «KMUStorys» des Swiss Venture Club (SVC) ist über alle gängigen Podcast-Apps wie Apple Podcasts, Spotify, TuneIn oder Google Podcasts erhältlich. Zudem ist er über die Website des SVC sowie auf den Radio- und Today-Seiten von CH Media verfügbar. Nik Hartmann beleuchtet im Gespräch mit KMU-Persönlichkeiten die grossen Geschichten hinter den kleinen und mittleren Unternehmen der Schweiz.

In this episode of Infrastructure Matters, hosts Steven Dickens and Camberley Bates cover the Rubrik IPO, Oracle's positioning in the cloud market, plus IBM's Storage announcements. Key topics covered:  Rubric IPO: Rubric, a data protection company, went public with a $5.6 billion valuation, emphasizing its scale-out data protection capability and its focus on cybersecurity. IBM Earnings and Acquisition: IBM reported solid earnings, with notable growth in software and hybrid cloud, and announced the acquisition of HashiCorp for $35 a share, enhancing its open-source support model. IBM Storage Announcements: IBM introduced Storage Assurance Perpetual, a program aimed at keeping customers' storage infrastructure current over an eight-year period, and unveiled enhancements to its virtualized storage product, SVC, focusing on replication and mirroring capabilities. Google Cloud Growth: Google Cloud's revenue surged 28% year-on-year, nearing $10 billion for the quarter, signaling strong sales execution and growth momentum in the enterprise market. Oracle Developments: Oracle showcased its Exadata platform's cloud connectivity and cost-effectiveness, positioning itself as a competitive player in the IaaS space. Larry Ellison's involvement highlighted the company's AI strategy and its integration with the Cerner acquisition for healthcare innovation.  

In this episode we are joined by Jenny O'Leary - the Marketing Coordinator for the Livermore Valley Wine Growers. It has been a while since we spent time with a wine country guest. Jenny gives us a good look into what you should know this summer. As well as sharing her story as another one of those Fremont transplants who has found a new home in the Livermore Valley. We discuss wine country's challenges, its relationship to the rest of the Tri-Valley economy, and where she believes we are headed. As always, she shares a few of her favorite local Livermore spots to hang out, whether with the kids or flying solo with the hubby. Tune in for an insightful and lively conversation with SVC and JTM! For more information on wine country happenings, check out their website at https://www.lvwine.org/ Learn more about TASTE 2024 - the Livermore Valley Wine Country Signature Event. And if you want a pantry refill on the freshest spices in the Tri-Valley check out www.jtminthekitchen.com

In this episode, we are joined by Owner and Founder of The Muffin Lab - Janneh Merritt. Brooklyn-born & raised foodie was brought to the West Coast by the emerging tech industry. After spending over a decade in the industry, in June of 2023, Janneh decided to go all in on himself. Launching the Muffin Lab! Like many of our guests, Janneh is a licensed cottage operator, allowing him to turn his home space into his place of business and kitchen. Specializing in English Muffins, he has spent the past several years dialing in his recipe, helping to re-invigorate the local breakfast sandwich scene. Tune in for an awesome conversation alongside JTM & SVC. Muffin Lab can be found weekly at various Tri-Valley Farmers Markets and pop-ups. You can also order daily deliveries online anywhere in Tri-Valley. As always, if you enjoy what you are listening to, follow us and be sure to share with a friend who might be looking to take their independent business to the next level. Support JTM now by checking out his website at www.jtminthekitchen.com for the best local spices on the market.

Contributor: Travis Barlock, MD Educational Pearls: Cancer-related emergencies can be sorted into a few buckets: Infection Cancer itself and the treatments (chemotherapy/radiation) can be immunosuppressive. Look out for conditions such as sepsis and neutropenic fever. Obstruction Cancer causes a hypercoagulable state. Look out for blood clots which can cause emergencies such as a pulmonary embolism, stroke, superior vena cava (SVC) syndrome, and cardiac tamponade. Metabolic Cancer can affect the metabolic system in a variety of ways. For example, certain cancers like bone cancers can stimulate the bones to release large amounts of calcium leading to hypercalcemia. Tumor lysis syndrome is another consideration in which either spontaneously or due to treatment, tumor cells will release large amounts of electrolytes into the bloodstream causing hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Medication side effect Immunomodulators can have strange side effects. A common one to know is Keytruda (pembrolizumab), which can cause inflammation in any organ. So if you have a cancer patient on immunomodulators with any inflammatory changes (cystitis, colitis, pneumonitis, etc), talk to oncology about whether steroids are indicated. Chemotherapy can cause tumor lysis syndrome (see above), and multiple chemotherapeutics are known to cause heart failure (doxorubicin, trastuzumab), kidney failure (cisplatin), and pulmonary toxicity (bleomycin). References Campello, E., Ilich, A., Simioni, P., & Key, N. S. (2019). The relationship between pancreatic cancer and hypercoagulability: a comprehensive review on epidemiological and biological issues. British journal of cancer, 121(5), 359–371. https://doi.org/10.1038/s41416-019-0510-x Gyamfi, J., Kim, J., & Choi, J. (2022). Cancer as a Metabolic Disorder. International journal of molecular sciences, 23(3), 1155. https://doi.org/10.3390/ijms23031155 Kwok, G., Yau, T. C., Chiu, J. W., Tse, E., & Kwong, Y. L. (2016). Pembrolizumab (Keytruda). Human vaccines & immunotherapeutics, 12(11), 2777–2789. https://doi.org/10.1080/21645515.2016.1199310 Wang, S. J., Dougan, S. K., & Dougan, M. (2023). Immune mechanisms of toxicity from checkpoint inhibitors. Trends in cancer, 9(7), 543–553. https://doi.org/10.1016/j.trecan.2023.04.002 Zimmer, A. J., & Freifeld, A. G. (2019). Optimal Management of Neutropenic Fever in Patients With Cancer. Journal of oncology practice, 15(1), 19–24. https://doi.org/10.1200/JOP.18.00269 Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII  

A familiar voice joins Team TTG - Nakoah hits the microphone with us and let's us help bring in the day. We spin the tires on some local happenings in the food and beverage world. Followed by diving into a great blind tasting of 3 wines provided by SVC. Tune in and see if you can't guess the varietals alongside JTM & Nakoah. Be sure to subscribe and leave a review on the podcast! We appreciate the continued support - until next time! Find us on Instagram @TTG_Podcast

Welcome to the 63rd episode of Triple KO! Triple K.O. is a bi-weekly fighting game podcast featuring Matt McMuscles, Maximilian Dood, and Justin Wong. In this episode, Matt, Max, and Justin are joined by a guest from Thorgies Arcade to discuss all the craziness to do with Fighting Game Stories, Lore, and more!0:00 Tekken 8 Story Mode2:05 The Story of Virtua Fighter3:23 Thorgies' Research for BlazBlue4:57 Fighting Game Lore is Complicated7:15 Important Lore Put in Pachinko Games11:17 The Story of Marvel VS' Games12:42 Marvel 2 Comic Book Lore15:38 SVC Lore17:11 Villain Turnover in KoF22:07 More Tekken Story Mode28:11 The Story of Killer Instinct30:29 Mortal Kombat Story Lines38:26 Street Fighter Story Lines45:35 Bloody Roar Lore51:59 Thrill Kill & Time Killers53:11 The Best Fighting Game Stories1:07:19 The Worst Fighting Game Stories1:25:57 Wrapping UpThis show is part of the Spreaker Prime Network, if you are interested in advertising on this podcast, contact us at https://www.spreaker.com/show/5455911/advertisement

These two cases examine the CAAF's jurisdiction when deciding on writs filed by SVCs. Specifically, the CAAF decides whether they have the authority to review decisions made by the CCA's when asked by an accused, and by an SVC, respectively. Connect with The Judge Advocate General's Legal Center and School on Facebook (tjaglcs), LinkedIn (tjaglcs), or visit our website for more resources at https://tjaglcs.army.mil/leapp You can also connect directly with the Criminal Law Department on Facebook (tjaglcs_crimlaw) or Instagram (tjaglcs_crimlaw)

These two cases examine the CAAF's jurisdiction when deciding on writs filed by SVCs. Specifically, the CAAF decides whether they have the authority to review decisions made by the CCA's when asked by an accused, and by an SVC, respectively. Connect with The Judge Advocate General's Legal Center and School on Facebook (tjaglcs), LinkedIn (tjaglcs), or visit our website for more resources at https://tjaglcs.army.mil/leapp You can also connect directly with the Criminal Law Department on Facebook (tjaglcs_crimlaw) or Instagram (tjaglcs_crimlaw)

In this episode, we'll be uncovering the silent signs of blood clots that you need to know. Blood clots can be dangerous and even life-threatening, so it's important to recognize the symptoms and seek medical attention if necessary. We'll be discussing the different types of blood clots and where they can occur in the body, including the risks of stroke, pulmonary embolism, heart attack, and SVC syndrome. By understanding the signs and symptoms of blood clots, you can take steps to protect yourself and your loved ones. Don't forget to leave a positive review if you liked this episode! --- Send in a voice message: https://podcasters.spotify.com/pod/show/jake-schmutz/message

We are joined by a great friend and long-time industry vet, Justin Lebon owner and proprietor of Lebon Restoration & Woodwork. This episode is steered by SVC & JTM as Matt was in Wisconsin recording a docuseries for the CrossFit games. Nevertheless, we were able to put together a great episode and conversation. Justin is another one of those Fremont transplants who made their way to the Livermore Valley and never left. He spent a decade at Uncle Yu's right here in the heart of downtown as the GM and every other position. And when the pandemic hit, he was pressed to make some hard decisions about what was next. Join us for another deep dive into what it takes to push yourself to be your best. And we are reminded again that banking on yourself is always the best bet. If you are enjoying this content, leave us a review and help us climb the podcast leaderboards as your favorite podcast to listen to.

We get back to the roots in this episode as we shoot the shit to some cool natural wines brought in by SVC. Listeners have been requesting a few wine-centric episodes and here you are! We explore some cool wine-making styles alongside Sidewinder Distiller & Occasio Winemaker Dave Hendrickson. Dave has been a somewhat regular voice on the podcast over the last several years and it is always a treat to taste some cool things alongside him. SVC leads the charge on this episode and offers some cool wines that we have not yet tried on this podcast. So be sure to grab a glass of your favorite natty beverage and let's get after it. Tune in anywhere you listen to the noise and be sure to hit that subscribe button to get all the latest details.

In this episode of CTSNet's flagship podcast, editor in chief Joel Dunning runs through the latest, most popular content on ctsnet.org—the largest online community of CT surgeons and source of CT surgery information—and breaking cardiothoracic surgery news and research from around the world. Joel discusses minithoracotomy versus sternotomy for mitral valve repair, an AATS consensus on management of patients with early-stage non-small cell lung cancer, and wedge resection versus lobectomy for lung cancer with lymph node disease. He also talks about a case of Ravitch and mitral valve repair for a patient with Marfan syndrome, SVC cannula insertion and removal technique, and a CTSNet exclusive interview with Loretta Erhunmwunsee about her cross-cultural work in thoracic surgery. After discussing upcoming events in the CT surgery world, he closes with a shoutout to Tom Varghese and David Cooke for their podcast, Same Surgeon, Different Light. JANS Items Mentioned Minithoracotomy vs Conventional Sternotomy for Mitral Valve Repair: A Randomized Clinical Trial  The American Association for Thoracic Surgery (AATS) 2023 Expert Consensus Document: Staging and Multidisciplinary Management of Patients with Early-Stage Non-Small Cell Lung Cancer  Wedge Resection vs. Lobectomy for Clinical Stage IA Non-Small Cell Lung Cancer with Occult Lymph Node Disease  CTSNet Content Mentioned Concomitant Ravitch Repair and Mitral Valve Repair in a 13-Year-Old Patient with Marfan Syndrome Percutaneous Insertion and Removal Technique of Bio-Medicus Cannula as SVC Cannula for Cardiopulmonary Bypass Cultural Humility in Surgery: An Interview with Loretta Erhunmwunsee Other Items Mentioned Same Surgeon, Different Light CTSNet Events Calendar

We are nationwide VA-Accredited Disability Lawyers helping veterans get the rightful benefits they deserve. Tune in most Wednesdays (sometimes Thursdays) afternoon to get answers for your pressing disability questions LIVE. For a FREE Case Evaluation go here: https://www.hillandponton.com/free-ca... Visit our website at https://www.hillandponton.com/?utm_so... Like us on Facebook at www.facebook.com/HillandPonton For questions please email us at Info@hillandponton.com Speaker: Attorney Carol Ponton Agent Kerry Baker The content of this YouTube channel is provided for informational purposes only and is not intended to constitute legal advice. You should not rely upon any information contained on this YouTube channel for legal advice. Viewing this YouTube channel is not intended to and shall not create an attorney-client relationship between you and Hill and Ponton, PA. Messages or other forms of communication that you transmit to this YouTube channel will not create an attorney-client relationship and thus information contained in such communications may not be protected as privileged. Hill and Ponton, PA does not make any representation, warranty, or guarantee about the accuracy of the information contained in this YouTube channel or in links to other YouTube channels or websites. This YouTube channel is provided "as is," does not represent that any outcome or result from the viewing of this channel. Your use viewing of this YouTube channel is at your own risk. You enjoy this YouTube channel and its contents only for personal, non-commercial purposes. Neither Hill and Ponton, PA, nor anyone acting on their behalf, will be liable under any circumstances for damages of any kind. 00:00 - Intro 00:30 - The examiner changed the code of my S-C Mechanical back to Lumbo Strain. W ill that help with my DDD & Scoliosis get approved? 03:27 - Rating LTR has errors - Mild Radiculopathy (10%) instead of moderately severe. Take to an HLR to correct or not? 05:20 - 2nd error. I saw an issue of IU raised by VRO to CP but no reply or wrong answer to question? Is this a raised by the record issue? 06:41 - I went to a Burn Pit Examination and the examiner advised me to put in a claim for RLS due to Gulf War Illness. 09:14 - Submitted for Anxiety and major Depressive, SVC connected migraine 12:38 - If an appeal is remained back is that a good thing? Or is it best for the VBA to give a decision? 16:13 - What's the difference between an AMA claim and a Legacy claim? 28:55 - Their decision said it's P&T so they have not scheduled me for any more C&P's. If corrected would that be considered a medical sep/retirement? 52:47 - If C&P MD examiner confirms SC but the rater decided not to agree because of conflicting info in medical records. HLR in order? 53:40 - How does one get a copy of their Army Medical Records? From 1968/69. 54:19 - I have my 3 claims denied without going to C&P. The list of evidence listed on the Letter of Decision was different from what's uploaded to VA page. 56:19 - Buddy who served in Vietnam but his records were destroyed in the fire. His DD 214 only says he was deployed to Okinawa. 1:00:18 - Also can you explain what “duty to assist” means? 1:04:34 - Are you seeing cases of CKD, Neuropathy, and Afib related to JP5 in drinking water on carriers? 1:07:56 - Can a review result in an increase or decrease to an existing claim?

Today Eric dives into the world of fish care with Dr. Jesse Sanders, a veterinarian specializing in taking care of aquatic animals. Dr. Sanders is really passionate about fish, and she talks about the different things we need to consider when it comes to taking care of them. Dr. Sanders also gives some helpful tips on properly caring for fish and talks about the challenges that pond owners face.   In this episode, we talk about… Fish veterinarians and how their presence in the industry has evolved over the years. The challenges and complexities of providing veterinary care for fish, particularly koi The complexity of fish medicine Understanding the trends and progress of aquatic veterinary medicine Various aspects related to the identification and treatment of fish ailments Incidents where freshwater fish were mistakenly placed in salt water and vice versa, and the result of that Responsible and informed practices to ensure the well-being of fish Being cautious when adding new fish to a pond How a single fish carrying parasites can trigger an infection in the entire pond The three-year pond syndrome Risks associated with introducing fish from colder regions, such as Japan The need for more accessible and affordable fish veterinary care The advantage of being a mobile veterinarian Reportable diseases in fish — koi herpes virus (KHP), spring viremia of carp (SVC), etc Fish spawning when performing large water changes or deep cleanings in ponds. Cyanobacteria (a.k.a red slime) treatment in saltwater aquariums  Perceptions of a "perfect" marine tank   Mentioned Dr. Sanders' Website    Dr. Jesse Sanders on LinkedIn    Links to resources:    The Pond Digger - https://theponddigger.com/   You can also check out The Pond Digger's products at: http://helixpondfiltration.com/    TWT Contractor Circle   TWT Contractor Power Circle   And follow his adventures in the pond world at: Instagram  Facebook  TikTok

CardioNerds (Amit Goyal and Daniel Ambinder), ACHD series co-chairs Dr. Dan Clark and Dr. Josh Saef, and ACHD FIT lead Dr. J.D. Serfas (Duke University) and Cardiology Fellow Dr. Victoria Thomas (Vanderbilt University) join ACHD experts Dr. Jamil Aboulhosn (Professor of Medicine at UCLA and the director of the Ahmanson/UCLA Adult Congenital Heart Disease Center) and Dr. Joanna Ghobrial, Medical and Interventional Director of the Adult Congenital Heart Disease Center at Cleveland Clinic. They discuss common ACHD pathologies that benefit from interventional cardiology procedures such as transcatheter pulmonic valve replacement (TPVR) and share new advancements in transcatheter approaches to correct sinus venosus defects. They end with a brief discussion on how to become an adult cardiology interventionalist that performs ACHD interventions. Episode notes were drafted by Dr. Victoria Thomas. Audio editing by CardioNerds Academy Intern, student doctor Akiva Rosenzveig.  The CardioNerds Adult Congenital Heart Disease (ACHD) series provides a comprehensive curriculum to dive deep into the labyrinthine world of congenital heart disease with the aim of empowering every CardioNerd to help improve the lives of people living with congenital heart disease. This series is multi-institutional collaborative project made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Josh Saef, Dr. Agnes Koczo, and Dr. Dan Clark. The CardioNerds Adult Congenital Heart Disease Series is developed in collaboration with the Adult Congenital Heart Association, The CHiP Network, and Heart University. See more Disclosures: None CardioNerds Adult Congenital Heart Disease PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - ACHD: Interventional Cardiology The ductus arteriosus, which is formed from the distal portion of the left sixth arch, is key to fetal circulation because it allows blood to bypass Transcatheter pulmonic valve replacement (TPVR) is a treatment for many ACHD patients that can spare them repeat sternotomies. This is important as many ACHD patients hava already undergone multiple surgeries in their childhood.   Before any ACHD cardiology intervention, appropriate imaging (TEE, TTE, Cardiac MRI, Cardiac CTA, and/or 3D printing) is imperative to understanding the relevant anatomy and hemodynamics to guide procedural indication and planning.    As with other structural interventions, consider a SENTINEL device (cerebral embolic protection system) to provide embolic protection in procedures that could lead to debris/embolic dislodgement when appropriate. Sinus venosus defects can be repaired via a transcatheter approach with a covered stent in the superior vena cava (SVC).   Consider using 3D printing or 3D digital imaging when preparing for complex ACHD interventions.    Notes- ACHD: Interventional Cardiology 1. When considering a patient for TPVR there are 3 types of landing zones for pulmonic valves in ACHD patients:    Pulmonary conduits or homografts. These are typically seen in patients with TOF or prior Ross or Rastelli procedure. These may be calcified and stenotic and so pre-dilatation is often needed before valve replacement.   Bioprosthetic Valves. (Valve in Valve TPVR) Native outflow tract 2. What are some of the more severe complications to consider when talking to an ACHD patient about a TPVR?   Coronary artery compression Conduit rupture Vessel injury (including the pulmonary bed) Valve embolization Endocarditis 3. What are some of the hemodynamic measurements one would want to pay attention to in a patient with a Fontan heart?    You will see higher CVPs in patients with a Fontan palliation.

CardioNerds (Amit Goyal and Daniel Ambinder), ACHD series co-chairs Dr. Dan Clark and Dr. Josh Saef, and ACHD FIT lead Dr. J.D. Serfas (Duke University) and Cardiology Fellow Dr. Victoria Thomas (Vanderbilt University) join ACHD experts Dr. Jamil Aboulhosn (Professor of Medicine at UCLA and the director of the Ahmanson/UCLA Adult Congenital Heart Disease Center) and Dr. Joanna Ghobrial, Medical and Interventional Director of the Adult Congenital Heart Disease Center at Cleveland Clinic. They discuss common ACHD pathologies that benefit from interventional procedures such as transcatheter pulmonic valve replacement (TPVR) and share new advancements in transcatheter approaches to correct sinus venosus defects. They end with a brief discussion on how to become an adult cardiology interventionalist that performs ACHD interventions. Episode notes were drafted by Dr. Victoria Thomas. Audio editing by CardioNerds Academy Intern, student doctor Akiva Rosenzveig.  The CardioNerds Adult Congenital Heart Disease (ACHD) series provides a comprehensive curriculum to dive deep into the labyrinthine world of congenital heart disease with the aim of empowering every CardioNerd to help improve the lives of people living with congenital heart disease. This series is multi-institutional collaborative project made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Josh Saef, Dr. Agnes Koczo, and Dr. Dan Clark. The CardioNerds Adult Congenital Heart Disease Series is developed in collaboration with the Adult Congenital Heart Association, The CHiP Network, and Heart University. See more Disclosures: None CardioNerds Adult Congenital Heart Disease PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - ACHD: Interventional Cardiology The ductus arteriosus, which is formed from the distal portion of the left sixth arch, is key to fetal circulation because it allows blood to bypass Transcatheter pulmonic valve replacement (TPVR) is a treatment for many ACHD patients that can spare them repeat sternotomies. This is important as many ACHD patients hava already undergone multiple surgeries in their childhood.   Before any ACHD cardiology intervention, appropriate imaging (TEE, TTE, Cardiac MRI, Cardiac CTA, and/or 3D printing) is imperative to understanding the relevant anatomy and hemodynamics to guide procedural indication and planning.    As with other structural interventions, consider a SENTINEL device (cerebral embolic protection system) to provide embolic protection in procedures that could lead to debris/embolic dislodgement when appropriate. Sinus venosus defects can be repaired via a transcatheter approach with a covered stent in the superior vena cava (SVC).   Consider using 3D printing or 3D digital imaging when preparing for complex ACHD interventions.    Notes- ACHD: Interventional Cardiology 1. When considering a patient for TPVR there are 3 types of landing zones for pulmonic valves in ACHD patients:    Pulmonary conduits or homografts. These are typically seen in patients with TOF or prior Ross or Rastelli procedure. These may be calcified and stenotic and so pre-dilatation is often needed before valve replacement.   Bioprosthetic Valves. (Valve in Valve TPVR) Native outflow tract 2. What are some of the more severe complications to consider when talking to an ACHD patient about a TPVR?   Coronary artery compression Conduit rupture Vessel injury (including the pulmonary bed) Valve embolization Endocarditis 3. What are some of the hemodynamic measurements one would want to pay attention to in a patient with a Fontan heart?    You will see higher CVPs in patients with a Fontan palliation.

Join Matt, SVC, and JTM as they take another stab at talking about small businesses and the Livermore Valley economy. We are having a blast digging into why businesses choose to open here in Livermore and what factors are contributing to their staying. We open this episode with a deep dive into what superpowers are important, you won't want to miss Savannah's claim to universal domination. It is rare to say, but the pandemic may have been one of the best things to happen to the region. Small businesses, locals, and wine country are chomping at the bits for what we all believe will be one of the best summers in recent history. Tune in and join the conversation - TTG is back at it and trending in the right direction! Hit that subscribe button and share with a friend!

Yo - we could not be more excited to launch our fifth season of Through The Grapevine Podcast a.k.a. TTG_Podcast if you're nasty! As always, we are recording in the beautiful Livermore Valley Wine Country at the Advance Creative Studio. Savannah and I are jacked to take another round around the sun with you all. Our goal is to bring you closer to the movers and shakers of the Tri-Valley and Livermore Valley Wine Country. This season we hope to take a deeper dive into what makes small business work, together alongside owners and entrepreneurs, we will peel back the curtain on how small businesses stay competitive in a highly-competitive marketplace. For our first episode, we are joined by the Owners of Crossfit Livermore (CFL), Matt Souza & Grace Elliot Souza. Throughout the last two seasons, you have heard SVC and I talk about the importance of health, and for us, that means CFL. So to start off season 5 we wanted to take a dive into fitness and health and the importance of it for all those that hope to have a big year! Tune in now baby we are live - and be sure to hang on until the end of the podcast where we introduce season five's newest addition. New Year - New Co-Host. And don't forget to hit that subscribe button and set those notifications to stun, it's go time!! TTG Let's Ride

SVC 20th Anniversary Sermon: A Preaching Record of God's Faithfulness (Various Passages) by Sun Valley Church

방송일 : 2023년 3월 15일 KBS 열린토론 / MC 정준희 KBS 1 Radio FM 97.3MHz 월-금 19:20-20:30 주제: SVB 초고속 파산 충격, 국내 은행은 안전한가? 1. SVC 파산 사태, 원인과 파장은? 2. SVB 파산, 국내 금융권은 안전한가? 출연: 김학균 센터장 (신영증권 리서치센터) 이정환 교수 (한양대 경제금융학부) 차영주 소장 (와이즈경제연구소)

Christina Goldbaum, NYT, with stories of women living under Taliban rule // Chris Sullivan's Chokepoint -- 520 flyover delay // Matt Markovich on alternate "paths" to graduation/ charging prison inmates for family visits // Dose of Kindness -- a $5,000 tip for a server // Gee Scott on bailing out banks // David Fahrenthold on the SVC collapse/ the 2024 race for the White HouseSee omnystudio.com/listener for privacy information.

Jennifer Hensley is a marketing strategist and the owner of Playmaker Coaching & Consulting LLC— dedicated to changing the game for referral-based business owners. By creating and implementing 90-day marketing plans with her clients, Jennifer helps them scale sustainably without the hassle or hustle. Jennifer worked with Northwestern Mutual for over 18 years before becoming the owner of Playmaker Coaching & Consulting in 2019. She graduated from the University of Missouri-Columbia with a Bachelor's in Marketing and earned her Chartered Financial Consultant and Chartered Life Underwriter designation from The American College of Financial Services.   Jennifer joins me today to offer advice on branding for financial advisors. She outlines the SVC branding framework and discusses what factors financial advisors need to consider when creating a branding strategy. She explains how financial advisors can elevate their branding if they're not active on social media. She also highlights how advisors can avoid getting overwhelmed when beginning marketing work for their business and underscores the value of creating a playbook for branding success.   “Start by showing up: comment on others' content, give free resources, or add value. Starting there can make a huge difference, and you wouldn't have to worry about how much you need to post every day.” - Jennifer Hensley   This week on The Model FA Podcast:   Jennifer's background and career at Northwestern Mutual The “Strategy, Value, and Consistency” framework for branding Tracking and identifying client segmentation and ideal clients Jennifer's advice for being more consistent with branding work The three circles of people who will see your content The importance of adding free value to other people How financial advisors can elevate their branding if they're not active on social media Creating a library of content for repurposing and reusing The branding minimum viable product every financial advisor needs to have   Resources Mentioned:   Book: One Word that will Change Your Life by Dan Britton, Jimmy Page, and Jon Gorden Book: The Four Tendencies: The Indispensable Personality Profiles That Reveal How to Make Your Life Better (and Other People's Lives Better, Too) by Gretchen Rubin Book: Find Your Yellow Tux: How to Be Successful by Standing Out by Jesse Cole   Our Favorite Quotes:   “The reality is if you want people to care about your stuff, it starts by you caring about theirs. You need to interact with them first to make interaction happen.” - David DeCelle “It's important to not just put together a plan but also a plan of execution, and a plan around how you're going to review and reassess.” - David DeCelle “Being strategic, value-based, and consistent helps advisors create aim and focus, rather than just going all over the board and hoping something will work out.” - Jennifer Hensley “Advisors often have a lot of ideas all the time and immediately take it all and adopt it all, at which point they struggle. Trying to make it manageable makes it more consistent.” - Jennifer Hensley   Connect with Jennifer Hensley:   Playmaker Coaching & Consulting Email: jennifer@PlaymakerCoach.com Jennifer Hensley on LinkedIn Jennifer Hensley on Instagram   About the Model FA Podcast   The Model FA podcast is a show for fiduciary financial advisors. In each episode, our host David DeCelle sits down with industry experts, strategic thinkers, and advisors to explore what it takes to build a successful practice — and have an abundant life in the process. We believe in continuous learning, tactical advice, and strategies that work — no “gotchas” or BS. Join us to hear stories from successful financial advisors, get actionable ideas from experts, and re-discover your drive to build the practice of your dreams.    Did you like this conversation? Then leave us a rating and a review in whatever podcast player you use. We would love your feedback, and your ratings help us reach more advisors with ideas for growing their practices, attracting great clients, and achieving a better quality of life. While you are there, feel free to share your ideas about future podcast guests or topics you'd love to see covered.    Our Team: President of Model FA, David DeCelle   If you like this podcast, you will love our community! Join the Model FA Community on Facebook to connect with like-minded advisors and share the day-to-day challenges and wins of running a growing financial services firm.

In this episode, we discuss the approach to a patient with SVC syndrome. This includes considering both malignant and non-malignant causes. Treatment focuses on relief of the obstruction and investigation and management of malignant causes. Our medicine minute discusses a 2021 trial reviewing endovascular therapy for SVC syndrome.Written by: Dr. Samuel Chan (Internal Medicine Resident)Reviewed by: Dr. John Goffin (Medical Oncologist) and Dr. Andrew Cheung (General Internist)Podcast recorded by: Alison LaiInfographic by: Jessica Nguyen (Medical Student)Support the show

In this episode, host Dr. Michael Barraza interviews Dr. Rehan Quadri, interventional radiologist, about the definition, indications and techniques for treating clot in transit.  We begin by defining and describing when to treat clot in transit. Traditionally, the definition is the washing machine mobile clot in the right atrium (RA) or right ventricle (RV). In these situations, the next place for the clot to travel is the pulmonary artery (PA). Mortality in these cases can reach as high as 30%, which is why these cases are considered emergencies. There is another category of clot in transit where a clot is partially adhered to a vessel wall, catheter, or heart valve. They are most commonly diagnosed via an echocardiogram, or found incidentally on a CT angiogram. They commonly present as catheter malfunction with symptoms resembling SVC syndrome. Dr. Quadri explains his usual method for retrieving clot in transit, though he notes each case is complex and different depending on the etiology and the overall status of the patient. In general, unless there is a massive PE, he treats the clot in transit before the PE. He always ensures with the preoperative echocardiogram that there is no interatrial shunt or patent foramen ovale (PFO). At the beginning of the case he checks PA and RA pressures.  He uses a 24 French Inari Flowtriever with FLEX technology, which helps with tough angles. He uses ICE guidance in all clot in transit cases. To help with orientation when using the ICE catheter, he recommends pointing it anteriorly while entering the RA, then using the Eustachian ridge, an echogenic line in the RA, to confirm you are in the RA and indicating that you should see the tricuspid valve as you advance. He uses the FlowSaver device, and always has 2 units of blood in the room just in case. At the end of the case, he remeasures the PA pressures, then injects through the Inari sheath to verify that there is no residual before finally doing a pulmonary arteriogram. He sends all the clots to pathology, and has seen that the morphology is usually mixed, with some organized fibrin in addition to acute thrombus.

Mr. Andrew Nickinson, Mr. Aminder Singh, and Mr. Manj Gohel discuss the diagnosis and management of venous disease.  Miss. Leanna Erete oversaw content development.  Originally published on Nov 28, 2021.  Check out our ebook chapter for additional details on EHIT, coagulation factors, anticoagulants, PERT, SVC syndrome and lymphedema. Vascular Surgery Exam Prep eBook - Venous Disease Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and #jointheconversation.

This podcast, Dr. Peter Eckman, a cardiologist and heart failure specialist, with Minneapolis Heart Institute, discusses heart failure and why it is an extensive medical issue. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Recognize heart failure as a problematic clinical disease and its morbidity and mortality that leads to comprehensive medical management. Identify and describe optimal contemporary medical therapy for heart failure. Describe novel options for heart failure. CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES:  *See the attachment for additional information.  Heart Failure (HF)- Can occur without congestion or fluid retention - Characterized by fatigue, fluid retention, SOB, PND, orthopnea - We should consider the same urgency for heart failure as patients with CAD and CA. Heart Failure Preserved/Reduced Ejection Fraction (HFpEF/HFrEF)- HFpEF is a Preserved Ejcetion Fraction over about 50% - HFpEF - congestive phenotype more of a fluid retention       - an exercise intolerant phenotupe where the patient becomes intolerant of exercise induced dyspnea.       - Pulm HTN phenotype       - Increased pressure in the heart that gets transmitted to the lungs - HRrEF is Reduced EF is usually below 40% Medications- 4 classes of medications (MRAs, BB, SGLT2, ARNIs) - Treatment with mineralocorticoid receptor antagonists (MRAs) has been demonstrated to improve clinical outcomes in patients with HFrEF with mild to severe symptoms and also in patients with left ventricular dysfunciton after myocardial infarction. - SGLT2 inhibitors reduced the risk of cardiovascular death and hospitalizations for heart failure in a broad range of patients with heart failure, supporting their role as a foundational therapy for heart failure, irrespective of ejection fraction or care setting. - ARNI (angiotensin receptor/neprilysin inhibitor) medication is a newer treatment for heart failure. The combination of sacubitril and valsartan has helped people live longer and have a better quality of life. - Comprehensive EF therapy involves BB, ARNI, MRAs, angiotensin receptor/neprilysin inhibitors. Spironolactone, SGLT2 inhibitors. Treatment- Traditional therapy usually involves a BB and ACE inhibitor. - Currently we should be looking at comprehensive therapy when it comes to HF treatment.       - STOP USING LISINOPRIL.- SGLT2 inhibitors contraindicated ketoacidosis, amputation UTI, weight loss       - (SGLT2 inhibitors) DAPA-HF trial showed that dapagliflozin was superior to placebo at preventing cardiovascular deaths and heart failure events among patients with heart failure.  (Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1911303#article_citing_articles ) - Catheterization - a vast majority of HF patients will need a right heart catheterization. - Cardiac pulmonary pressure monitoring Cardio MEMS - same day outpatient surgery which helps with medication adjustments and hospitalization in half. Works regardless of EF. - CardioVere laser spectroscopy which uses different wavelengths to detect light characteristics to determine the level of edema/fluid present wihin someone's tissues. Currently in development. - Casana is a toilet seat with certain sensors that detect and monitor impedance that check levels between different tissues, monitors HR and weight. - Cardiac contractility modulation causing electrical stumulation during a particular contraction of the myocyets it will augment potential (like a pacemeaker). -CORCHINCH - HF trial catheter based device that cinches up the heart, thereby making it smaller. It works more efficiently.  (Source: Clinical Evaluation of the AccuCinch® Ventricular Restoration System in Patients Who Present With Symptomatic Heart Failure With Reduced Ejection Fraction (HFrEF): The CORCINCH-HF Study) Novel Treatments- Atrial shunting procedure is investigational trials. Potentially impactful in exercise capacity and pressures but stay tuned as the verdict is not out. HfPEF exercise induced intolerance may be the best candidate. - SVC trial feasibility trial more durable effects of cardiac output.  Stay tuned. - LVAD for advanced therapies. Sometimes a bridge for candidacy as well as recovery. - Biventricular pacing has shown promise. *Heart failure is a problematic clinical disease entity with significant morbidity and mortality often leading to comprehensive medical management. It is often beneficial to enlist the help of our heart failure colleagues for these complicated patients.  Thanks to Dr. Peter Eckman - MHI heart failure specialist for his knowledge and contribution to this podcast. Please check out the additonal show notes for additional information/resources.

CardioNerds Cofounder Dr. Amit Goyal is joined by an esteemed group of UCLA cardiology fellows – Dr. Patrick Zakka (CardioNerds Academy Chief), Dr. Negeen Shehandeh (Chief Fellow), and Dr. Adrian Castillo – to discuss a case of primary cardiac angiosarcoma. An expert commentary is provided by Dr. Eric Yang, beloved educator, associate clinical professor of medicine, assistant fellowship program director, and founder of the Cardio-Oncology program at UCLA.   Case synopsis: A female in her 40s presents to the ED for fatigue that had been ongoing for approximately 1 month. She also developed night sweats and diffuse joint pains, for which she has been taking NSAIDs. She was seen by her PCP and after bloodwork was done, was told she had iron deficiency so was on iron replacement therapy. Vital signs were within normal limits. She was in no acute distress. Her pulmonary and cardiac exams were unremarkable. Her lab studies showed a Hb of 6.6 (MCV 59) and platelet count of 686k. CXR was without significant abnormality, and EKG showed normal sinus rhythm. She was admitted to medicine and received IV iron (had not consented to receiving RBC transfusion). GI was consulted for anemia work-up. Meanwhile, she developed a new-onset atrial fibrillation with rapid ventricular response seen on telemetry, for which Cardiology was consulted. A TTE was ordered in part of her evaluation, and surprisingly noted a moderate pericardial effusion circumferential to the heart. Within the pericardial space, posterior to the heart and abutting the RA/RV was a large mass measuring approximately 5.5x5.9 cm. After further imaging work-up with CMR and PET-CT, the mass was surgically resected, and patient established care with outpatient oncology for chemotherapy.  CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media - primary cardiac angiosarcoma Episode Schematics & Teaching Pearls – primary cardiac angiosarcoma The pericardium is composed of an outer fibrous sac, and an inner serous sac with visceral and parietal layers.   Pericardial masses can be primary (benign or malignant) or metastatic. There are other miscellaneous pericardial masses.  Imaging modalities for the pericardium include echocardiography, cardiac CT and cardiac MRI. There is also role for PET-CT in pericardial imaging for further characterization of pericardial masses.   Cardiac angiosarcomas are extremely rare but are the most common cardiac primary malignant tumors.  Evidence-based management if lacking because of paucity of clinical data given the rarity of cardiac angiosarcomas. Surgery is the mainstay of therapy. Radiotherapy and chemotherapy are often used as well.  Notes – primary cardiac angiosarcoma Pericardial Anatomy  The pericardium is a fibroelastic sac composed of two layers.   Outer layer: fibrous pericardium (

Jon decided on HVAC because he felt there was an opportunity to use his technological background and create efficiencies in the industry. 00:00:00] Welcome to the Successful Life Podcast. I am your host Corey Berrier, and I am here with my man, Jon Jordan. What's up, Jon? Hey Corey, how's it going? Good, man. Good to see you. So Jon is gonna bring some pretty cool information to us today, and I tell you, I'm, I've been really excited about this and I would wish we could have done this earlier, but, things happen and here we are. [00:00:24] But, so Jon owns a couple of companies Comfort Monster is the one that we have had the most conversations about. And you've got locations here in Raleigh and then in Charlotte, which is an HVAC company. And then Atlantic bt, which is where you started, right? Yep, Absolutely. So tell us about, tell us a little bit about that journey, Jon, if you don't mind. [00:00:46] It's definitely a long journey. I'll try to keep it relatively short, but I was in college and the first entrepreneurial idea I had was essentially a way to send prescriptions from the doctor's office directly to the drug store. Came up with this idea where you put a kiosk, a mini ATM in the [00:01:00] doctor's office. [00:01:01] So back, this is way back in 98, you'd write a handwritten prescription, you'd have it, and at that point, you'd have to go wait at the pharmacy. This system actually allowed you to, in the waiting room, choose a pharmacy stick in your prescription. It would scan it and send it across town. So when you drove over there, it was already filled. [00:01:15] That was pretty unique at the time we were working with all the major pharmacies, including Walmart and some of these big guys, to build that system out. So that's where my technology background started. And then, we morphed into providing more custom solutions. [00:01:28] And we've continued to work with publicly traded companies, everything from governments to publicly traded companies to build. Technology solutions. So that's, that was my first company. And I still own that company. And at some point, it got to where there were other managers that were more wanted to have more responsibility, and I just stepped back and said, Hey you want to do that? [00:01:47] That's great. I'll take some time and relax a little bit. And I did that took a couple of years. I spent a lot of time in Turks and CAOs and doing other things that weren't terribly productive. And then at a certain point I really had the, just woke up. I was like, You know [00:02:00] what,  [00:02:00] you're wasting your talents and your time. And I felt like I needed to do something else. And so I looked around and a lot of people said why didn't you get into doing something, some kind of software? And I said I really, I've always grown up working on things and. And the technology business is very intangible. [00:02:16] You build things, but they're all nothing you can really touch. And I wanted to see my trucks driving around town and I wanted to I just wanted something that was a little more tangible. So looked at a number of different businesses and came up with the H V A C as being one that people practices that I'd learned working in the technology and the space where you really are competing highly for talent all the time. [00:02:36] And also how to apply technology and create efficiencies. I believe that H V A C was a prime opportunity to leverage those things that I had experience in. I did not realize that I, so I, of course, knew about the software company, but I don't know that I've ever asked you too many questions about it, and I really didn't know that the prescript, I had no idea that was part, that was something that you had a part of. [00:02:59] I, I just didn't [00:03:00] know that. That's fascinating. Which makes this next conversation even more fascinating because yeah, you knew nothing about H V A C, but you looked at this, as you just said, you looked at this as an opportunity to implement some sort of software into an industry maybe that is lacking. [00:03:18] Is that kind of what you were saying there? Yeah. Essentially what I, the common knowledge is, one of the things I read at the time was you should never enter a business that's essentially sat saturated or highly competitive unless you can I think it was something like, unless you can find some way something that's, 15, there's a 15% differentiator, some sort of an X factor that can create a 15% differentiator. [00:03:41] And I said I don't think I can come up with one thing that's 15%, but I believe I can do 15 things that are 1%. And so I identified things like the brand and if you're familiar with our brand, it's very unique. A lot of H V C and service companies are starting to come up with much more personable, unique brands. [00:03:55] But we were early in that process, let's just say that. And so that was a [00:04:00] differentiator. And things like having our number, being 9 1 9 Monster something memorable and friendly was unique where most people at that time were Joe's H V A C and the number could. As complicated as possible. [00:04:11] 9 1 9 7 3 5, 1, 8, 6 2 or something. You're like, that's gonna be hard to remember, So well, Jon, and I want, I just, we gotta, I have to highlight for a moment about your brand because in a couple of things, one, our friend, our mutual friend, Dan Antonelli, did your brand at Kick Charge. [00:04:31] Absolutely. And so, Dan does unique brands, and I think your brand stands out amongst anybody in this city because it's bright. It's probably not the most attractive thing necessarily that you would think of, but what it does is it makes you look at it, it doesn't matter if it's attractive, but what matters that the eyeballs stay on that van and it does, and you've captured. [00:04:56] A significant audience, I believe, with that. Now the [00:05:00] next thing I want you to tell and I hadn't actually planned to ask you this, but I'm really glad that I remembered the reason that you and I started talking and you and I had, I don't know, lunch or dinner about a year and a half ago and you told me a story about about a little girl or about kids that you, the story about the kids on the side of the road. [00:05:17] I want you to tell that story because it's unique in that it's a brand opportunity, not that you used that as a brand opportunity, cuz that wasn't the intention. The intention was to do something outta the goodness of your heart. But I would like for you to share that story because the result works pretty cool. [00:05:35] Yeah. So I'm gonna try to, there are so many different things I could say here. I'm gonna try to keep it somewhat concise. I. The brand. Of course, you are the expert on selling and how that happens and what the best way, to do that is. But one of my core beliefs is that you can't have a sale without having trust. [00:05:52] And one of the things that are important about our brand is it's a, it's somewhat a personification of trust. Our monster, I was laughing a [00:06:00] little bit when you said that the brand wasn't attractive. Our monster, we consider him, we talk about him as he's you as an actual, personified thing. [00:06:08] His name's comfy and Comfy doesn't like any sort of criticism like that. And he thinks he is very attractive. In fact, he thinks he's a model. And on our page is a meat comfy. And he, he's modeling with his hand up behind his, behind his head cuz he is so attractive and he takes special care of his fur and all this kind of stuff. [00:06:24] But the point of all that is to be. To be friendly when you're friendly and open and self dep deprecating, that's a bridge to building trust. And of course, trust is what's necessary when you're in people's homes and helping them to fix problems and sometimes explaining complex issues and or asking them for one, a gigantic amount of money to either fix or replace certain things. [00:06:46] I think all of those things are wrapped into the brand. And a friendly, trustworthy mascot is a big part of of a memorable brand, but also a brand that engenders trust to the audience you're trying to reach and you [00:07:00] use. And by the way, when I said it wasn't attractive, that was a complete misrepresentation because clearly, it's attractive to people. [00:07:05] Look at it, right? It's too late now. He's probably listening, and you probably are. And not his favorite. That's probably right at this point, but I'll try to straighten it out with him later. But you, but Jon, you used a piece of your brand to comfort. I remember you telling me a story, but you Oh, yeah. [00:07:21] Okay. So that's right. You did ask it, but I didn't, I never answered your question, so that's alright. Yeah. So here's what happened. I was driving in a neighborhood and we always carry the, I didn't mention this either. We carry little stuff monsters, little stuffed, comfy, and it says, on the tag, it says, Hi, my name is Comfy. [00:07:36] And, it has the website and all that kind doesn't say much about HVAC, but it just says, comfort monster.com. Anyway, so driving in the neighborhood and it had just rained and a guy and his two kids were splashing through the puddles or whatever. [00:07:50] And I was in an unmarked truck, a pickup truck, but didn't have our logo on. I drove. Past them. And I went up the street, and then I stopped and I was like, You know what? I'm gonna go, I'm gonna go back and talk to this guy. I [00:08:00] had to think about it. I was like, Is this gonna be super creepy or, so I back up and I rolled down the window, and I said, the guy said, Hey. [00:08:05] I said, I just had to come back. I said, you guys just look like you were having so much fun splashing around the puddle. And I've got this, this little monster here. I said it would be okay if I give it to you to your kids. [00:08:15] And he said, Oh, absolutely. And, we chatted for a minute or two and gave him the monster. And then I drove off. And before essentially I even got back to the office. We had a review, and the guy said something along the lines of, I, I've never used this company. [00:08:27] I didn't know them until today, but they, one of their employees took the time to stop and do this. And if they employ people like that, then they're gonna. B R H V C company from now on. And so we, we encourage that from all of our people, and they do that. [00:08:43] They, again, it's a, in this day and age, you gotta be a little bit careful when you're driving a van and giving away, toys, whatever. No. But again, the brand is very, friendly and they don't, they do it in a careful way, but they definitely, if they see somebody who might enjoy comfy or whatever, they've got [00:09:00] dozens of 'em on their trucks and they're encouraged to pass 'em out, whether they're customers or not. [00:09:04] That's one way that we share goodwill and share our, spread our brand. Without asking people, for business, we're just saying, Hey, here's who we are. Here's our, here's a comfy mascot and enjoy it a thing. It's kind, it's the law, reciprocity. [00:09:17] And I'm not saying that you do it intentionally for that, 'cause I believe your intention is completely pure with this. But the law reciprocity, that's, this is when it kicks in, right? Because you give right? You give the kid the toy, and the family is now they're a fan and they're gonna use your company, right? [00:09:34] Absolutely. Yeah. We, yeah, you don't, Reciprocity shouldn't be used as a tool, but it's still, but it's still a thing. When you give something for the right reasons and you don't expect anything back, then maybe you do get something back. That's, that's reciprocity as far as I'm concerned. [00:09:49] Wonderful. But yeah, you don't, it's not mercenary. It's not the little mercenary reciprocity. It's just reciprocity. Do something good, and you get something back maybe. Yeah, because if you do it with the intention of getting something, [00:10:00] Most likely you're not gonna get it back anyway Exactly. All right. So I want to dive into what you've been working on because this is, this is what I've been super excited for you to talk about because first before you talk about that, I want you to talk about how you got to this conversation, how you started thinking about, how you started the software that you're gonna tell us about. [00:10:20] Yeah. It's been a long process. I, when I first started the business, I definitely intended, this was, almost six years ago, and things have evolved since then. But the journey I was on, I said, All right, I don't, I've looked around. I don't think that I'm gonna be able to do what I wanna do uniquely, in the business. [00:10:36] I think the other part of this is if if your listeners haven't read or been exposed to Purple Cow Seth Go Goden I think the official name of the book is Purple Cow transform your business by being remarkable. Anyway, the idea is I knew I wanted to build a remarkable business and I didn't think I could do it with unremarkable software. [00:10:53] And having a technology background, I guess I wanted to build something. Anyway, so started out, spent a lot of [00:11:00] money, even though we were a technology business, we still gotta spend money and spent a lot of money developing something. It became overwhelming just in terms of how much further we had to go with it from the ground up. [00:11:12] And I was like, Look, this is, the business is starting to get expensive. The growth capital is starting to be expensive. And then the development on top of that is starting to get ridiculous. And so I started looking around and that's when Service Titan was really raising a bunch of money and there was a lot of press around them. [00:11:27] And I said, You know what? They're gonna have an open API and whether I, your listeners are familiar with that, but essentially the ability to connect into their database and do some custom things. Pull data out, push data in do things. I said You know what, we can take this core system, we can customize outside of it, and then we don't have to spend all the money on the core platform. [00:11:45] And we can focus on the things that make us unique and that'll be a better strategy. So we don't So you're telling Clear Jon, so basically at this point you're thinking of, I'm gonna build something on top of Server Titan. That's what you're saying, right? Correct. Yeah. Correct. So we dumped, I don't know, a million and a half dollars of [00:12:00] development we'd already spent. [00:12:01] We said, All right, forget that we're gonna, use the Service Titan. And so we, we did that. And I just don't think there it hasn't worked out exactly the way I had intended because we haven't been able to customize it. The core interface is still the core interface, and anything we do is hanging off of it, which means people are still using multiple. [00:12:18] Systems. And that hasn't doesn't fit exactly the way. It doesn't allow us to innovate the way we want to and so forth. And there have been some other frustrations I've had, with their technology. I'd be happy to share those things as well. But yeah, I'd I'm curious actually. [00:12:30] Yeah. What are things that you've experienced? My biggest frustration is I believe that H V A C, especially home services in general, but H V A C especially, is, needs to be a data-driven business. If you went to a major retailer L Brands, which is, Victoria's Secret, all that stuff, or Walmart or, any of these guys, they don't do anything without analyzing data. [00:12:51] Their retail data is everything because there are so many customers, and so many transactions, they can learn so much and customize their decision-making [00:13:00] process entirely around that data. H V C business, that's one of the things I love about it. You don't have my technology business. [00:13:06] We got you. Dozens of customers, but there are dozens of customers and the relationships exist for years and all this kind of stuff. You can't pull a lot of data out of those, just the basic customer engagement. But when you're h HPC company, you've got 10,000 customers. [00:13:21] You can start to make smart decisions about what solutions you present based on what's parked in the driveway because there's so much data that can help drive those decisions and everything. Our concept is you can take somebody who's a good technician and make 'em great with data. Take somebody who's great and make 'em excellent. [00:13:41] Same with sales. Take somebody who's, who's mediocre and make 'em good because you can make, you can drive when they hit, quote if it already interprets all the data that it has to interpret and makes those types of decisions, you can do some pretty cool things. . My biggest complaint about Service Titan is that just the core, [00:14:00] anytime I ask, and I've been very open about this, maybe we didn't implement it properly. [00:14:03] But anytime I ask a question that has a data component to it, every time I get back and answer, and I've got smart people that are running these things and pulling, pulling more data out and doing more stuff to it than I think anybody else is. And they're always like I don't know if this is really accurate but it should be and it drives me crazy. [00:14:22] I'm like, What? What do you mean? If the technician did this instead of this, then this isn't gonna be this way. And the data doesn't end up in a normal structure which means we can't, it, it makes it difficult for us to work with. And that's the point of data, right? [00:14:35] Is to have structure, to know exactly where the checks and balances are, to know exactly what to do next without that data in the right order. It, sounds useless to me, right? Yeah, that's, and again, I, that's my, been, my frustration is that I'll, and I'll be given data and I'll make decisions off of it. [00:14:53] And then it turns out that maybe that data wasn't so accurate, to begin with. And again I will take full responsibility that perhaps we haven't implemented [00:15:00] it to the letter the way that other companies have. I, I know there are a lot of people that use it. But that's my number one complaint. [00:15:06] Then there's synchronization. In, software, in technology, we say if it syncs, it stinks. So the concept, the core concept behind service type is you're syncing between the service type and platform and your accounting platform. Service Titan isn't an accounting platform. [00:15:22] It syncs with QuickBooks, it syncs with Sage, I believe maybe another one at this point. But anytime, So you're having to batch your invoices and other things out of service Titan into your accounting system. Now, if you have a change after the fact, somebody you have to, do a refund or, whatever happens now you're out of sync and you've gotta Reba and Resync and it's just, it's again, you're always, you're dealing with two different data sets. [00:15:42] And that's a problem. You mentioned ago six different, didn't you mention, I think when you said the example you just gave, I think you were saying a moment ago, like there were, there's multiple of those that you have to use, plugins, right? Yeah. Hundred [00:16:00] percent. [00:16:00] Yeah. Just as far as accounting goes, I think, they support QuickBooks and Sage. But again, those are batched processes. As far as, but there are tons of modules. That's one of the things they have developed a marketplace, and there are people that, that develop quoting systems and booking systems and other things that, you know, that, that connect with Service Titans, architecture over those they call it APIs is how that works. [00:16:20] But it's less functional than I think what you're about to say. Yeah. It's better. Pulling and pushing data out is better than a closed system, but a full system that's all integrated on the same backplane is better. And when we went out and we didn't want to develop something from the ground up, that's what we started doing, to begin with. [00:16:39] And that has its own challenges in terms of scale and also time to market and other stuff like that. So we looked at an e r P system and e r P is short for enterprise resource planning, which doesn't really mean anything to anybody. Really should, shouldn't even mean anything to me, I can't believe I still call it that. [00:16:55] But the concept is, it's a, it's an everything. The big companies, 50,000 people, [00:17:00] whatever, they've run on e r P systems for years, and the concept is that's their backplane. And it does everything from accounting to the help desk, to field service. It's even got a lunch order module. [00:17:11] So if you're gonna have a meeting, and everybody can put their lunch orders in there, and then you can, send that out to wherever you're gonna order from or whatever. So the concept is, it's all on one backplane. And you build modules that do that, do things. [00:17:21] And there's a difference between a module that lives on the backplane and one that lives outside of the system. Service Titan, you got the Service Titan Software. When you log into Service Titan, all you're ever gonna see is Service Titan. But you could have a quoting system. I'm trying to think of one of the ones that integrate with company Cam, maybe? [00:17:38] Yeah. Something yeah. Something like that. Yeah. So it can have, where it can share data, but it's still a separate browser window and it's not, doesn't live inside of Service Titan. A module and something that's an add-on in the marketplace is different things and I use the concept, the term backplane, it's not really a technical term, but the idea is essentially its actual software that's installed into [00:18:00] the core software system versus something that lives outside and just exchanges data. [00:18:04] But for the listeners, it sounds like that's probably, there's a greater chance of having miscommunication in a system like that, right? Because you've got multiple parts moving, Correct? Yeah. If it relies on I don't wanna get too technical cuz it just doesn't. But we call it a system of record. [00:18:22] Anytime you have a, you have data, you wanna have a clear system of record and you really can't answer the question, What's your system of record for the account for an invoice? Is it QuickBooks or is it Service Titan? At a certain point, the system of record of service Titan, cuz that's the only place the invoice exists. [00:18:39] After it gets batched and sent over to QuickBooks, then QuickBooks becomes the system of record. But your customer care people are not working inside QuickBooks. So now if you wanna send a copy of that invoice, even if it's been credited in QuickBooks somehow, cuz you wrote it off or something, it still exists in Service Titan. [00:18:54] So just the concept, it's not that there's, that they've done anything wrong, it's just if it sinks, it [00:19:00] stinks because there's, once you have two copies of an invoice and that's exactly what happens. You batch those invoices, you send 'em out to QuickBooks, and now you got two copies of 'em. So which one do you operate on? [00:19:07] And when you make a change in QuickBooks, it's not coming back, to service Titan. It's only one-way. It's a one-way batch process. And that has drawbacks. Certainly, they've got best practices for how to work around that, which is essential that, that if you make those changes, you need to make 'em in service tight, and then you Reba 'em out to the finance system. [00:19:23] But the same thing with employee time records. Okay? You're getting time records in Service Titan, but you're actually paying your payroll in QuickBooks, so you're having to, that data gotta be shared and stuff. Whereas one of the things, that drives me bonkers is that I can't get really accurate financials. [00:19:39] Again, maybe an internal issue, but it's delayed significantly from the end of the month waiting for the, we call it the tail, the paper tail, to come back. You have a post with a vendor and they deliver the product, but then they don't invoice. And so if you don't get the paper right in Service Titan until you [00:20:00] receive the invoice in QuickBooks, you don't technically have you know you've got a PO but you don't technically have an expense on your books. [00:20:07] And so it takes us a long time to have an officially closed month cuz we're waiting for that paper tail to come back. I want to know, my goal is to make it like a restaurant, which every night we close the restaurant. I wanna know, did we make money today or did we lose money today? Cause if we made money today and let's do it again tomorrow, if we didn't, then let's figure out why we didn't, and let's not do it again tomorrow. [00:20:31] If I've gotta wait a month and a half before I see a month of financials. And then I've gotta try to dig through that to figure out what the heck went wrong with our margin that we slipped 6% in our materials this month. I've already, the train's already down the tracks. A month and a half. [00:20:46] I'm gonna lose three months. From the day I could have made a correction to the time that I'm even informed enough to start to dig into it. I'm the aggregate time is potentially I, alright, maybe it's not quite three months, but from, if it's [00:21:00] day 1st of June and I don't get my financials accurate until July. [00:21:05] So one month and then probably really I'm looking at nearly the end of July to get my accurate numbers from June and then I gotta start making actions on that. So maybe I'm two months plus or in the neighborhood two months before I can make action that of something that happened back in, back on June one. [00:21:22] You can't run a business that way. You can get yourself in real trouble that way. That's. It's like an airplane, right? An airplane. If it gets off one degree, you are going nowhere near where you're supposed to be going. And that's what you're saying. You're able to catch that degree every single you're gonna tell us about that, right? [00:21:38] Yeah. You so let's just dive into how you're solving all these problems that, that you've come across. Yes. And so it comes down to the concept of the E R P, which is if I create that, if I create that PO then, then I can act on that, that, and that's integrated into my financial, it's not, hasn't become an invoice yet. [00:21:57] But I can still treat it as if it is an invoice [00:22:00] inside that system. But then I can pull everything together. We've built a daily p and l report that's a budget and a p and l all in one. And it starts with some of our top-of-the-funnel metrics. Things like How many service calls did I expect to get today? [00:22:14] How much did I budget for today? And how many did I actually get? Because I wanna be able to hold our sales team accountable. They say if you make the phone ring, we'll make the bank sing, right? So if I'm like, Hey, look, we said we all did this budget together. We said that we were looking for 40 diagnostic calls today. [00:22:30] We delivered 43, 43 calls got booked, and, our service revenue is not where it should have been. I'll use your words. And I had a guy that was president in one of my companies a long time ago, and he would, anytime he was talk, you were talking to him, he was like, writing something down like this, and you write it down. [00:22:46] And then later, sure enough, that notebook would come out, and he'd say, So now you make the phone ring. We'll make the bank sign. He's you said that, right? I didn't say that, and you're like, Yeah, no, I said that. I'd say We said we were gonna get, 43 service calls [00:23:00] and you thought that was right and you did your budget based on that. [00:23:02] Is that right? Yeah. Okay, then we made the phone ring, But you haven't made the bank thing. Is that correct? ? And it's just one of those accountability things. So starting at the top of our sort of p and l, it's not really a p and l it's an amalgamation of stuff. But the very top is your top line funnel metrics where you're like, okay, we expected to get 43 diagnostics. [00:23:18] We call 'em svc one internal code name, but service one calls is diagnostic. Then service two is a major repair that stems, from that diagnostic. Then service three is a recall, a service four is a warranty, so you have your top line metrics of how many things you expect at the book into all those categories. [00:23:33] And then you have your revenue numbers that come out of those categories. And then you got your sales leads, and then you got your actual sales, and then all that funnels down into your sectional p and ls. And this is on a daily basis, your service one. We expected to get $20,000 of revenue and service, today. [00:23:50] What did we actually get? Then we expected our labor costs to be this, and that's coming directly outta the ERP. So as they track time on that day, when they finish their day, we know what [00:24:00] their general, hourly rate's gonna be. We know how many ti, how many hours they track, and to which types of jobs they track them. [00:24:05] So now I can look at my daily gross profit on just that service one. So obviously you think your service one diagnostics are gonna be your most profitable calls and I hitting my, 50, 55%, or whatever, and these metrics are for that gross profit inside the service one. [00:24:21] My service two is hitting their gross profit metrics, and then on, So then you go all the way down, and then that gives you your gross profit. Then you've got your general administrative costs and your marketing and everything else. And then at the very bottom line. And those are somewhat Those aren't necessarily coming out of the e r p, you're projecting them because they don't they're lumpy. [00:24:39] They don't all come in, evenly but you're projecting what your monthly G costs are gonna be. And then at the very bottom line, you got your net, your net income, your projected net income for that day. But you shouldn't have to worry about the tail of the paper because everything's happening. [00:24:53], I consider residential H V A C to be a relatively retail business. You're not doing long-running projects. Your installs are [00:25:00] ours, at least ours are essentially one day. Our service calls are hours, not days. Repairs. Your hours not days. And so essentially we should be able to close the store every single day. [00:25:10] And then I can look at that, by 10 o'clock the next morning, I should be able to look at that and say, Okay, did we make money yesterday? Did we lose? And then look at the, did we lose it because we didn't get enough stuff at the top of the funnel? Did we lose it because we didn't make enough hay outta the stuff we had in the funnel? [00:25:23] Did we overspend on parts? What did we do wrong? Or what did we do right? And if you can look at it every single day, then you can get to the destination that you wanna get to a whole lot better than looking in the rearview mirror and being so pissed Man if I would've just known, I could've fixed this a month and a half ago. [00:25:40] And it actually takes energy from you because if you see something that was wrong yesterday and you can change it today, that creates energy when you're like, man. I found something recently I'll be honest about it. We found that we were paying sales tax on service parts and in North Carolina we pay you don't pay sales tax [00:26:00] on, you pay sales tax on the replacement stuff because the customer doesn't pay it. [00:26:04] It's considered a capital improvement, so we don't, so the customer doesn't pay it on replacing a system which means we do pay it the to the vendor for the equipment, but on service, they do pay tax. So we don't pay tax the on the service parts. We've been paying taxes on the service parts that we're buying from the vendors. [00:26:20] And the fact that it took us a significant amount of time to see that in the numbers when that when somebody made a change in the office to start doing that is a defeating sort of a process. You're like, Oh my gosh, we just paid, this six and a half, 7% on all these parts for this amount of time. [00:26:34] And it's taken so long to figure out that was what was going on. That doesn't create energy to fix things. It actually is. It takes your energy cuz you're a man, if I had known about this right away, I could've fixed it and saved a lot of money. [00:26:47] So you anticipate getting that energy every month because you're gonna be behind every month. Yeah. Yeah. Exactly. So whereas, one of the concepts I don't know if you promote, you've talked about it a lot on this show, but the Rockefeller Habits was, is, was a [00:27:00] really good approach to business. [00:27:01] And then it, it turned into traction eos entrepreneurial operating system. So Rockefeller became traction, eos. Anyway, one of the core concepts that came from Rockefeller that became traction, EOS is a daily huddle. And if you've got actual, broken down financials that you can use in your daily huddle and certainly your top-of-the-line metrics and stuff like that, then you say, Okay who's, marketing guys, Let's talk about the top of the funnel. [00:27:24] Okay, we, did we get enough diagnostics? Did we get enough? Sales opportunities. Do we do this? Do we do that? Yes, we're on, we're doing great, blah blah, what's our cost of leads? You cover that. And then, okay, now operational guys, did we sell, how do we do on our average tickets? How do we do on actually turning that stuff into results? [00:27:40] And it's all broken down for you, that way. But the only, that's not that unique. Everybody wants that. The problem is that if you don't have a back,  an E R P backplane, you can't get that kind of data outta your organization. And so that's the heart of what we're doing. [00:27:55] So let me I am curious, once you discovered the tax [00:28:00] state, all right, and that just, you don't have to give me obviously an exact number, but I'm just curious what that mistake cost you if you could have eliminated it in a 24 hour time period. Instead of how, You don't know, if you told us how long you actually were paying the tax on it? [00:28:16] Yeah, I'd be embarrassed to tell you that. So basically the number's staggering. Yeah, it's quite a lot. But we, there's a two-year statute I believe that we, so there's, we were within the amount of time that we could go and claim a what do you call it when you restate, basically restate your tax filings revised, amended we could amend our tax filings. [00:28:39] And so fortunately that's still, we haven't got the money back yet, but we're working on that. But yeah, it's certainly an issue. . The key thing though, Jon, is that, without you figuring this out, you wouldn't be having this conversation with me about getting that money back. You would, and anybody that's listening could be in this very same exact situation because look, a [00:29:00] lot of. [00:29:00] That I deal with. A lot of people that I know use, Service Titan, they use a lot, several different platforms, but a lot of people use Service Titan. Yeah. And so it's anyhow, so we won't, just to be fair, that's not there, That's our problem. That's not, that really can't be attributed to Service Titan other than the fact that not having everything, tight tightly enough, that's the only tie. [00:29:20] They, they're certainly not responsible. Yeah, for sure. I just mean, Yeah, exactly. I'm glad you clarify, but I should be able to look at my margin drift and analyze that margin better. And because the purchasing, inventory, invoicing, it's all it's not really tightly integrated. [00:29:36] And so that's where you have things like that can get by you, even if you're a decent business. Yeah, absolutely. All right, so the next thing I want you to talk about, which is to me it's the sort I think it's one of the more, more exciting things for me because I think it's one of the things that is just, it needs to be dialed in, which is the inventory. [00:29:57] I want you to dive into that for a moment. Tracking. Okay, what [00:30:00] I want, and let's go back to the daily, the concept of shutting this door down every single day. Inventory has been perfected by other companies for a long time. They mark things as a, B, and C-type inventory, representing the number of times it moves inside. [00:30:15] So A is your quick turn, your B is your medium turn. C is the stuff that sits a little bit longer. And then anything below a C is stuff you shouldn't even be carrying because it doesn't turn enough, right? Everything from inventory analysis to. Stocking restocks, all that stuff has been, has been done. [00:30:30] And what we want to be able to do is when somebody says complete on an SVC one, a diagnostic call, which doesn't involve any follow-up, I wanna know what our margin was on that job. And the only way I can actually know what a margin is on that job is by using a standard inventory price costing mechanism. [00:30:50] People use last in, first out, first in, first out average cost is all different types of methodologies you can use, but you have to use one of 'em. And [00:31:00] properly developed, designed inventory system will tell me when I pull that thing off the shelf, based on what I've chosen, what inventory costing model I've chosen to use, what that costs. [00:31:09] So if I know that my employee, my team member costs. Burdened 45 bucks an hour. And that this part, these parts that they used using a first in first out mechanism that these parts cost me $38 and I got this amount of revenue as soon as they hit complete on that job, I know what my margin was on that job. [00:31:29] And then that can all flow down into my, into that thing I was talking about earlier where I can see what the heck happened on an aggregate, basis. If I just, especially with raw costs changing rapidly, if I somehow vaguely think that this igniter or elbow, PVC elbow, or whatever we're using cost this amount of this amount, but it's because it never got updated in my system, then I could be, totally wrong. [00:31:53] But the whole constant between, these advanced inventory models are, there's a purchase order that's linked to that material. And when it gets used of the. Then [00:32:00] it decreases what I've got on the truck. So I know exactly what my balance sheet should say for how much I should have on the truck. [00:32:06] And then if I need to restock, it can decide whether to pull it from this warehouse or a different warehouse and what it costs, and how much I've got. So all these things are advanced things that nobody's gotta redevelop because they already exist. But service items are down to redevelop 'em because they didn't exist in Service Titan. [00:32:22] Their inventory model, and I haven't looked at it recently cuz we went in a different direction, but for the longest time, they had really no advanced inventory strategy. And then, finally, it's still this disjointed from the finance piece. So your balance sheet, even if service type knows how many three-quarter PVC, 90, 90-degree elbows you got in your, on all your stock, across all your stuff, it ain't gonna be reflected. [00:32:45] In your finances, so you're still having to try to back into a balance sheet somehow. On a daily basis, do I know how many, and how much my inventory's worth do I know how much is in trade and has been ordered but hasn't arrived yet? All these things are possible with a backplane that can support that level of [00:33:00] complexity. [00:33:01] So yeah, that I great answer. And I think this is; I think it's super needed. I want, one of the things I think that's pretty interesting is I want you to talk about, we're shifting between summer and fall right now, right? Yep. And you and I have talked about this several times about there's usually inventory that gets caught between seasons, right? [00:33:21] Yep. How have you figured out, have you figured out a way to eliminate that to a degree or lessen it? I think I've certainly come up with a way to maximize the use of capital as far as that goes. So we build four. We can build as many as we want to. We build four. For summer, winter, fall, and spring. [00:33:41] And the spring and the fall are transitional templates. And then those are also, and then they, there are sub-templates for each type of vehicle, whether it's a pickup truck or it's a van or whatever. And so what essentially happens is we've already predetermined that we need more furnace parts, in winter than we need summer parts. [00:33:58] Summer parts might [00:34:00] be capacitors, contactors drain parts, all that sort of stuff. Your winter parts are gonna be mortared furnace parts, your reversing valves, and things like that. So essentially, what we do is say, All right, this is our summer template. This is our winter template. [00:34:12] Somehow we gotta move from our summer template to our winter template, which means reducing certain things and stalking other things back up. So the transitional templates allow you to have some inventory numbers in the middle. So if I want to carry a. No, a thousand dollars worth of capacitors on my trucks in the summer, but I only want to carry $250 of them the in the winter. [00:34:34] The reason why that fall template is important is that you're gonna reduce your numbers. You might carry five of everything or three of everything in the summer, and I only want to carry one of everything in the win in the winter. If I bring that fall template in sometime in mid to late August, then it's gonna allow me to burn, to use my summer inventory down to that intermediate media level. [00:34:58] And then when I transition to the winter [00:35:00] template, sometime in late September, then I can, I'll get those numbers down even further. So what you're doing is you're bringing in winter inventory, maybe the fall template doesn't really bring in any winter inventory. We're not really gonna be using it, but it starts to sell down the summer inventory. [00:35:15] And then once I've sold down the summer inventory, I reduce it even further at the same time as I bring in that winter inventory. And it's as simple as just once you've built the templates and I hit a button that says we're gonna, let's start thinking about moving to, And everybody in the business, especially in North Carolina, knows it. [00:35:29] You're running strong July, the first week of August, the second week, August, she's Yeah, this is going great. And then it's Neil like the phone stops ringing like the third week of August because everything that has broken is gonna break, is broken. And it's still, it may still be 90 degrees, but it just, the wheel come off of the demand at that point. [00:35:47] And that's when you start making that transition. And it helps again, helps you to sell down that, that inventory. And you, on a large-scale operation, might be saving yourself parts that literally just gathered dust on the shelf. You [00:36:00] might save I don't know, 40, $50,000 worth of capital. [00:36:03] That that you don't need to have that can go into growth or something else. Or, I don't know. . No, that makes complete sense, I think. And I just think it, it's fascinating because I don't know anybody else that's come up with anything like this, that you're able to, it's able to essentially automate, the inventory or the seasons. [00:36:21] I think it, it's just, it's really cool. One other thing that I think is also great that we have not talked about, Actually, gimme a second. Cause I just lost what I was thinking. There was one more thing that I really wanted you to talk about, and I did. Was it related to recalls? Was that one of the things? [00:36:36] Yes. Yep. All right. Yes. So one of my frustrations, and again, I wanna be very clear that, so people don't be like, Oh, you're just using Service Titan wrong. Okay. I that's fine. I'll be more than happy to be we're not gonna go back to it, but I'll be more than happy to admit that we're not using it right Cuz I'm sure there are people that are doing it better than us. [00:36:54] But one of the problems that, that I've got with Service Titan is there's, [00:37:00] the way the recall process works is there's an, as, there's an assumption that it's clear enough that customer care can make a connection at the time the call is made. So a call comes in the service height model that somebody says I, you guys were just out here and I have another problem. [00:37:18] Okay. That by, by software. That's easy enough. I find that prior call, I say recall, and then I generate a new job that's based on that other job. And it, and it's, that's tagged as a recall. But I've got a real problem with that because I think psychologically we're setting ourselves up to give away money that we money and also goodwill or reputation that we don't necessarily have to give away. [00:37:40] So our approach is that everything is diagnostic. The only but your market is a diagnostic and a possible recall that makes the customer feel better. So the exact same scenario is Joe calls up, Hey, you guys screwed up. Yeah. You gotta come back out here right away. I want somebody this afternoon. [00:37:56] Immediately. You guys were just here, and we're like just here two months [00:38:00] ago. Yeah, but you were just here. Okay, Joe, we got you, buddy. We'll be there. We'll take a look at it. And he's I don't expect to pay anything for this. Okay, here's how we do this. [00:38:07] We're gonna mark this as a possible recall, but the first thing we do is always diagnose the issue. We diagnose it because if we go back on the assumption that we've made a mistake, then we're looking narrowly at the last thing we fixed. And what if there's a bigger problem and now you have another recall, and you still want to blame that on us, so Joe, what we're gonna do, we're gonna mark this as a possible recall. [00:38:29] The technician knows that if there's anything that we did wrong, that that there that you won't be charged for that within our, warranty policy. But all he's gonna do, when he gets there, he is gonna say, Joe, I'm here to diagnose the issue. And that's all you're gonna talk about in the begin with. [00:38:43] So now our technician is not when they get dispatched, and it says, recall in their mind, this is a $0 call, and they're not even prepared to defend the company or our prior work when they get there because they've already been told it's a recall. And then there's also a lot of complexity that [00:39:00] happens where, which, okay, it's a recall. [00:39:01] Was it the service guy that was there two weeks after it was installed, and now it's a recall on the service guy? Or is it a recall on the install? Or, is it something, is it a drain line or something that is draining into the side of their house into their wall that we never even touched? [00:39:18] As part of the re, we reconnected their drain line, but we, we didn't, we never re-piped it or anything like that, so anyway, so that's my point is that there's a much more complicated thing that has to happen with regards to recalls and we, we are building a process, and I say we're building cause we haven't completed this part of it, but we're building a process where we create a recall group and then we can evaluate to what percentage each. [00:39:43] Person who was involved contributed to the overall cost of the recall. So you have a recall group that says, Okay, there was an issue here. And we went back four times. Was Bill responsible for 20% because he should have called it originally? Was Jeff responsible for another [00:40:00] 20% because he didn't pick it up? [00:40:01] Pick this up the second time he was there. So what? And now, because we're getting this in real-time, we know what their drive time was, we know what their onsite time was, and we know what the parts used were. We can figure out the total real cost of what that recall was. But then we can also, in this recall group, we can assign a goodwill expense to it as well. [00:40:20] We can say this customer has now decided that they will, they had four systems, three of 'em were gonna go bad in the next two years, and they've decided they will never work with, with our company again. Of this debacle with this recall. So now we can assign a goodwill impairment to that recall group and say, Okay, this is what, this is our direct cost, This is our goodwill impairment, and this is what this overall recall cost us. [00:40:43] And so now when you're looking at your, you're looking at your financials at the end of the year and you're like, Hey, we did. We made 10% net; we're the greatest thing in the world. Hey, Jon, did you notice that our total cost of recalls, including impairments, was [00:41:00] $763,000? [00:41:01] Wouldn't you like to have half of that back? And we all deal with recalls. I'm not saying that I can take seven 63,000, and reduce it to zero but certainly, what comes out of that recall group is coaching. Because you can say, Okay, Joe, Bill was responsible for 20% of this. [00:41:16] And what were the skills that he missed? I can say it was low voltage; it was refrigeration, it was just sloppy work. What were the things? And now I can look at a scorecard for Bill at the end of the year, the quarter, or whatever, and say, Wow, Bill, you're doing great on, on sales, you're doing this, you're doing that. [00:41:31] But they, my God, we gotta get you some help in low voltage wiring because you're a train wreck, buddy. You're costing us $50,000 just because you don't know. The difference between the primary winding and secondary wiring winding. And I'll be honest, I'm thinking about taking your multi-meter because you don't even know how to use it. [00:41:48] And so if, but you don't know, unless you aggregate data, you don't know how to make it actionable. I see too much that people are like, Oh, Bill screwed this up. We gotta get rid of him or, [00:42:00] whatever because it was some lightning strike of a problem that Bill created. [00:42:03] But if you look at his record, isn't it, aren't there three other guys that are consistently losing you more money than Bill is? Even though this one was a big, big to-do. And that's where data, that's what I, you have to data; you've gotta be able to make decisions, you wanna be able to quickly get to insights. [00:42:18] Data's not important. Insights are important. And if you're properly managing data and properly reporting on data, then you can get insights. And when you get insights, you can make better decisions, and you can run a better, more profitable business. One thing I will be curious to find out, I don't know if it's been enough time yet for you to have the data, and I don't know when you changed your language pattern from TA saying it's a recall too, it's diagnostic, but I'd be interested to know what the, how that changed yours. [00:42:48] Closing rate or whatever metrics you measure by for those recalls or yeah, I guess you could measure it by the amount of money they collect because if normally it's a recall, it's gonna be free. So have you seen or got any data [00:43:00] on that? Do you know what the difference has been since you changed that language? [00:43:03] Yeah, as I said, this is being, this part of it's being built and hasn't been implemented yet. I'm just as curious as you are to see how this, how the recall. We call it our LR process roller [00:43:17] for short. Say it one more time, Jon. It doesn't matter whether the computer cut out our r l. Okay. R L R. We call it roller, Rlr roller, whatever, but the R is short for recall. And low revenue. So our process. Because it doesn't matter to us if a tech rolls up and doesn't hit, doesn't collect, it's not just collecting anything. [00:43:40] It's if the call when it's closed doesn't meet minimum gross profit standards, then they'll have, it'll enter the rlr process. And I don't, And again, the same way, we don't care on the front end, whether it's actually a recall or a diag, diagnostic. We're gonna treat everything as a diagnostic on the back end. [00:43:57] We're gonna treat everything as a low revenue, [00:44:00] or no revenue. I don't care, which either way, we didn't make money when we were out here. If it's low revenue, it goes into the RLR process. If it's a recall, it goes into the RLR process. And then somebody has to analyze that issue, and you do your first analysis and it never gets closed because we have unfortunately found that one recall, it's like coronavirus, you get one, you're gonna, you're gonna infect. [00:44:20] It just seems like that's how it goes. And so you create the recall group, and if you're lucky, it's one, but then, if you get a second one and then the third one, all of a sudden it's a, it is a runaway train. But that's the other thing that they can do for you, are you can recognize that pattern. [00:44:32] It's okay. When you hit your third recall, now all of a sudden, this is like general manager material. This is not something that just gets handled inside the company. It's okay, and we got three here. We're not getting a fourth. We need to go see what, see what's going on here. [00:44:44] Because that's, unfortunately, that's what happens is there's something that's not, that's hidden. And we battled some gas packs one time; it was before we realized that this was a common issue. But we, there was a low voltage short in a two-stage gas pack because one of the sensor wires on the, I think the high [00:45:00] pressure or whatever was rubbing against the. [00:45:01] The corner of the inside of the gas pack. And it only it was like, it was only when it would shift in a defrost that it would energize that sensor and short this thing out, or, Oh, sorry. Only when it went in the second stage when it would do this. And we were, we found other issues out there, and we were like, All right, we got this. [00:45:17] we found that some mice had chosen to chew the low-voltage wire. We're like, All right, that's gotta be it. Change that out, thermostat every time it, does this, it's, it's gotta be the thermostat, so you do this stuff, and you think that you're low v voltage is tricky anyway, and you think that you're solving problems, but turns into, three or four recalls before you know it. [00:45:35] And that's when you gotta say, Okay, let's stop. Know, send in our specialist, to deconstruct this so that we don't turn three or four into 10. And a customer that is calling the Better Business Bureau, and that's really what, and that's what you have to look forward to. [00:45:50] A bad review. If you go out there more than three times, you're probably not gonna get a great experience from that customer. And they will continue being a customer, not a chance. You might be pulling out that equipment [00:46:00] like over a wire rubbing on the cage. It takes a zip tie and a piece of electrical tape, and that customer's never gonna call you again. [00:46:06] But you gotta be able to, you gotta have a process to manage it, and then you gotta be able to interpret the data because things are happening. You can't be reactive in scale, a business. You gotta be system systematic. And that's where we're trying to go. [00:46:20] It's difficult. We've I thought I was gonna wave a wand at this thing. And oh, I'm successful in this business, this H V A C thing, it's gotta be easy. I'll figure this out in a couple of months, and I'll spend the rest of my life on the beach in Turks and Caicos. But it's been a humbling process. [00:46:34] There are so many moving pieces that you've got to have a system to manage them. And we've made mistakes and learned a lot from them. But we're pretty confident that this path we're on now is the right one. And we're seeing good results so far. [00:46:48] So I know that you probably know I was gonna ask you this would is this something that we talked about this? This is not something that you're pitching by any stretch. No. This is what you're using for your company, [00:47:00] but. But is this something that you could implement into a larger, say, $152 million, $200 million company? [00:47:07] Is that something you could possibly do once you get it completely done? Yeah, I think the thing about it is that there's gotta be a commitment to operations. It's not something it's because of its nature of it; it's complex. And so you'd have to be a certain size organization to benefit from it. [00:47:24] Cause when you start shaving pennies, it takes a lot of effort sometimes to get to where you can shave pennies. But at a large enough scale, those pennies out to a lot of money. And so it doesn't, I don't think it works for smaller companies. It's just too complicated. [00:47:36] And I don't mean complicated like you gotta be a, an MIT pH you know, a post-doc to run the thing. It's just that you've gotta be committed to certain operations. Because software and operations fit together. And I, we've certainly fought battles with our service technicians who are like this is too complicated. [00:47:55] I don't want to do all this. I hear you, but this is the right way to do things so that [00:48:00] we can have operational excellence. And if you're not interested in operational excellence, then I'll invite you to go to all of the mediocre companies that are out there. So you gotta have a certain operational approach and respect and ability within your team, to be able to do something like this. [00:48:15] But yeah, I haven't. You had, I had chatted briefly about it. I never set out to sell this because I want to build a world-class h a c company. And there's a difference between running software and building it for somebody else. You get into. Implementation teams and sales teams and all this other kind of stuff. [00:48:31] So I think where you and I landed was, I'm happy to discuss this with anybody who is interested in, like geeking out about software and technology and operational excellence. And we would consider my technology company has expertise in this, and we would consider working with anybody who sees the opportunity in something like this and sees the deficiencies and other approaches. [00:48:55] But we're certainly not actively looking to sell it because we're focused on operationalizing [00:49:00] it for ours. For sure. Dude, this has been such a great conversation, and people are gonna have to go back and listen to this probably because you've talked about so many different things that are super important. [00:49:11] And quite frankly, nobody's heard a lot of these things cuz it's the first time. I think you've talked about it publicly. I just made it all up so [00:49:21] how I do. Was that good? I think you did pretty well. Yeah, I think you did pretty well. You sounded smart. Exactly. No. Oh no, it's been fun. You get in the trenches of working on this stuff, and it's sometimes nice to talk about it. Because you get so deep into solving these problems and figuring 'em out. [00:49:36] It's nice to step back and have this conversation with you and talk about the potential and how exciting, it is. Cause it is, it is exciting, but it takes a lot of work to solve these problems in a way that, is scalable. And builds value enduring value in an operation that's got that process-driven approach to it. [00:49:55] Yeah. Somebody that, people that are listened to this that they hear this and they're like, Man, [00:50:00] that sounds like something I'd like that person's probably going to already be in. They're gonna be that 150 to 200. Because look, at the end of the day, as you said, this is not something for a smaller company because it's just too, probably too a little bit too technical, a little bit too sophisticated. [00:50:14] It Probably takes a lot of work for not a lot of gain potentially. Yeah, I think it's certainly a pathway to being If, if you're on your, if you're on a pathway to being that, that 50, 75, a hundred million dollar company, then you probably already got the same frustrations, and ideas. [00:50:30] If you don't recognize that there are deficiencies in what you may be doing now, then I don't think it's a fit. If you recognize the deficiency, you're frustrated. And, now, the issue there is that, there's a reason, there's an investment that has to happen. We've spent millions in, in, in our approach to it. [00:50:46] And that's because I didn't pull that outta my H V A C company; I pulled that out of our 20 years technology company. And I think that there's an investment that has to happen to make it operationalized it. And so that nexus of size and [00:51:00] and where you wanna take your company and all those different things have to come together in a way that's okay, yeah, that we can make this investment, we can make it in people, we can make it in technology. [00:51:09] And we have the management, manpower man or womanpower to implement this thing and make it successful. So all those things have to come together because you don't just implement a piece of software. You have to implement a business operation that runs on software. So if you don't fit those qualifications, there's no reason for you to reach out pretty much. [00:51:28] You just explained precisely the person that could use this. Yeah. No, I enjoy, I, I enjoy talking to anybody who's in the industry, and just, we can, like I said, I'm happy to talk to anybody. I don't wanna make some; We're definitely not. Our goal we haven't sold it to anybody. [00:51:42] We haven't; that's not our goal. Our goal is to build it for ourselves. But like you said we'd be, it'd be smart to have some conversations if other people are facing similar challenges and ha and are interested in having those conversations. Yeah, I think it's gonna, I think it, for sure. [00:51:56] Jon, this has been killer. Dude, I can't thank you enough. [00:52:00] If you would tell everybody where they can find you, Tell 'em the comfort monster wherever you want them to find you. Yeah, that'd be great. Yeah, if you wanna have some fun, go. If you go to comfort monster.com and then there's a, on one of the menus, it says Meet comfy. [00:52:12] It's a pretty funny page. It has his bio and what he likes, and some FAQs about him. It's just funny. But check that out. And but if you wanna get in touch with me, I'm easy to find Jon.Jordan@comfortmonster.com or Jon.Jordan@atlanticbt.com, short for Atlantic Business Technologies. [00:52:31] And if somebody's listening to this that wants to get in front in touch with comfort, what's the phone number there? Nine one nine Monster. Boom. That's right; you already said that. So appreciate you, Jon. This has been great. Thank you, man. All right, thanks, Corey. You got it.  

ABOUT THE EPISODE Saint Vincent College is bringing back wrestling and the Bearcats Head Coach Dominick Nania is ready to build the program up. Coach Nania was hired in May and has a whole year to recruit the SVC first class for the 2023-24 season. He enjoyed a standout four-year career for the Cardinals, serving as a three-year team captain and compiling 98 career victories. He was a two-time NCAA Division II National Championship qualifier and currently holds the program's records for wins, pins (42) and technical falls (17). He coached at the high school level, Hempfield and Norwin, and also coached at D2 Seton Hill. FOLLOW THE PODCAST https://anchor.fm/coachbonx2 | Twitter - @D3NationPodcast | Rokfin - @D3Nation ABOUT THE PODCAST Hosted by Anthony and Gennaro Bonaventura, former DIII wrestlers at Waynesburg University, current DIII Associate Head Coach at Stevens Institute of Technology & DII Head Coach at Fairmont State University. The D3 Nation podcast mission is to provide DIII wrestling news and updates throughout the year. We also look forward to delivering episodes featuring DIII coaches and wrestlers as special guests to share their stories. We are both passionate about DIII wrestling and want to use this platform to keep the wrestling community educated on what is happening in DIII plus raise awareness of the amazing stories in DIII Wrestling.

We are back with another round o tasting with a few of my favorite local wine lovers. We get back to some basics and go over a bit of the local news. Followed by jumping right back into a semi-blind tasting of 4 Sauvignon Blancs moderated by SVC. Only to be followed up by one more pass through 4 more Sauv. Blancs. The Livermore Valley is one, if not the oldest wine-growing region in America. And even though our roots are written all over the industry today, why haven't we been recognized by the greater market and industry as a region worth investing time, money, and interest in? There are a few theories out there, but for us here on TTG, we can help but think it has a lot to do with our varietal identity or lack thereof. Over the last few years, the Livermore Valley Wine Growers and various industry leaders have seriously considered both Sauvignon Blanc & Cabernet Franc as our regional identity. We are all about the hype, so we put the theory to the test and brought in 8 SBs from all over the world. Each showcases something unique about the varietal. This was a great tasting, and we are excited to see if you all can jive with SB as our flagship heritage white wine varietal. Tune in now, and don't forget to subscribe so you can stay up to date with all of our newest episodes and content. Follow on IG @TTG_Podcast

In this episode, we are joined by Alex Wolfe of Fraser-Howard Vineyards & GM over at 3 Steve's Winery here in the Livermore Valley Wine Country. Alex, Savannah, and Jeremy are a few representatives of the next generation of wine professionals helping to propel the Livermore Valley to new heights. Alex offers us his newest bottling of Chardonnay from the famed Fraser-Howard Vineyard and joins us for an SVC led blind tasting. As some of you know Savannah just took a new gig working with Chambers & Chambers as a portfolio specialist. Chambers is one of California's most prized books and it was a treat to taste a few of the wines from this book. The tides have turned and you won't want to miss JTM being blind tasted. Tune in to see if he can nail these blinds. We definitely geek out a bit on this episode so be prepared for a close-up look at how wine professionals go about deductive tasting. AND DON'T FORGET TO SUBSCRIBE!!!

It has been a few weeks since we published an episode, but we are excited to be back with Tracy Farhad. Tracy joined Visit Tri-Valley in January of 2020 as their newly appointed President & CEO. Halted by the pandemic Tracy takes us through her onboarding at VTV. She shares what it took for her and her new team to grind their way through the pandemic and speaks about some of its great things! We learn a lot about the many facets that make Agritourism what it is, more than just food and beverage. It is an industry of sports, conferences, and much more. The Tri-Valley is uniquely situated in the East Bay, nestled primarily on the 580 & 680 junctions. A bustling region of innovation, community, and hospitality the pandemic has really shown us our strengths here in this region. Tracy shares what she thinks makes the Tri-Valley special, how her organization serves its community, and most importantly, how she believes the Livermore Valley's best days are ahead of us. Tune back in and saddle up for a great episode with SVC & JTM as we get back into the groove of things at the Advanced Creative Studio. Video episode is available on Youtube! Please subscribe and share if you like what we are up to!

Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we talk all about first oncologic emergencies: superior vena cava (SVC) syndrome.Superior vena cava syndrome: Important: although we focus on a possible malignant mass in this discussion about SVC, other things can also cause SVC syndrome. How do you know about the chronicity of someone's possible SVC syndrome? Compare to a recent picture!Image of patient with collateralization with SVC syndrome: DOI: 10.1056/NEJMicm1311911Workup: Need to determine the etiology; imaging is important: CT of chest (CT venogram)Consider ultrasound to rule out thrombosis Get biopsy (eventually) if this is malignancy DDx of mediastinal masses: 5Ts:ThymomaTerrible lymphoma (B or T-cell)Testicular cancerTeratoma Thyroid malignancies Central line (causing occlusion) +/- clotSo now what? Yes, an answer to what is causing the issue is important, but we need to ensure that patient has a stable airway and temporize the situationOften requires input of specialists, such as Interventional Radiology or Radiation Oncology How to treat patients with SVC syndrome?- Chemotherapy: Important in chemo-responsive tumors (ex. germ cell tumors, lymphomas, small cell lung cancer); This can take a while to work -Placement of stents: Provides more immediate relief, but more invasive -Radiation treatment: Not always possible - Laryngeal edema/cerebral edema: steroids for life-threatening complications; Can affect diagnostic yield of sample and affect diagnosis, but may be required in emergent situations When is more emergent treatment indicated and consultants definitely need to be called (TELL YOUR CONSULTANT IF ANY OF THESE ARE SEEN!):Hemodynamic instabilityWorsening respiratory statusWorsening neurological status Final decision for what to do is often a multi-disciplinary discussion Stents: Provides quick reliefDoes not prohibit a diagnosis and curative treatment for the underlying malignancy Radiation: Takes several days or weeks; depending on underling histologyIf they have received prior radiation, they may not be eligible for more radiation A HUGE thank you to our special guests:Ryan Miller, MD, MS: PGY5 in Radiation Oncology at Thomas Jefferson University Hospital, Philadelphia, PA (https://www.jefferson.edu/university/jmc/departments/radiation_oncology/education/residency/residents/miller.html)Rupal Parikh, MD: PGY6 in Diagnostic/Interventional Radiology at the Hospital of the University of Pennsylvania, Philadelphia, PA (https://www.pennmedicine.org/departments-and-centers/department-of-radiology/education-and-training/residency-programs/current-residents/ir-integrated-residents/ir-dr-fifth-year/rupal-parikh-md)Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

We talk with Interventional Radiologist Dr. Carin Gonsalves about how her practice built a multidisciplinary Pulmonary Embolism (PE) Response team, including where to start, developing efficient workflows, and obtaining the equipment you need for success. --- CHECK OUT OUR SPONSOR Inari Medical https://www.inarimedical.com/ --- SHOW NOTES In this episode, hosts Dr. Michael Barraza and Dr. Aaron Fritts interview Dr. Carin Gonsalves, interventional radiologist, about building a pulmonary embolism response team (PERT) and the evolution of pulmonary embolism (PE) treatment including large bore suction thrombectomy devices and the importance of multidisciplinary effort in care of patients with PEs. Dr. Gonsalves discusses how she came to be Division Director of the PERT program at Jefferson University, and her collaborations with Geno Merli, cofounder of the PERT Consortium. Her interest in advancing PE treatment stemmed from her years of performing pulmonary arteriography and catheter directed thrombolysis before the inception of suction thrombectomy devices. She discusses the difficulty she had in obtaining these new devices, and how after 11 months of discussions, the hospital agreed to purchase the necessary equipment to enable the PE response team. She discusses how the PERT is activated when a patient presents with suspected PE. Her team is comprised of five subspecialties including IR, Pulmonary Critical Care, Vascular Surgery, Cardiothoracic Surgery, and Cardiology. She emphasizes how having a group of experts improves patient care by cutting down on critical decision time. She enjoys sharing the responsibility of evaluating treatment approaches based on the current literature and the diversity of experience in the group. Finally, we discuss advances in technology for treatment of PE. Dr. Gonsalves enjoys the ease of use and wide range of clots she can treat including acute, subacute and chronic. These devices have been game changers for PE; many patients are poor surgical candidates and have contraindications to thrombolysis. They end by discussing novel uses of these devices that Dr. Gonsalves performs including removal of clot in transit (mobile clot in the IVC, SVC, RA or RV) and vegetations on the tricuspid valve or a pacemaker lead. --- RESOURCES The PERT Consortium: https://pertconsortium.org Inari PEERLESS RCT: https://www.inarimedical.com/peerless/ Inari FlowTriever: https://www.inarimedical.com/flowtriever/ Inari ClotTriever: https://www.inarimedical.com/clottriever-int/ Inari FlowSaver: https://www.inarimedical.com/flowsaver/ AngioVac: https://www.angiovac.com

Engaging content is no longer optional and a strong brand can speak for you and drive more potential clients to buy, promote and recommend you. It's a trust accelerator. Learn the SVC Approach to engaging content: Strategic, Value-based, and Consistent. Walk away with a plan on what to post, when to post and how to engage. In this episode you will learn: What is the SVC approach and why it matters How to create a content library How to start sharing your brand message consistently Meet today's guest: Jennifer Hensley is theowner of Playmaker Coaching & Consulting, Jennifer Hensley, CLU, ChFC, created a winning system that has been proven to achieve top-tier results. With two decades of experience working with a Fortune 500 company, Jennifer has helped over 1500 small business owners achieve compound growth. Jennifer is on a mission to change the game for referral-based business owners to scale sustainably without the hassle or hustle. Jennifer's best teammates are her husband, Keith and daughter, Samantha who always push her to play her own game and stay on offense. She believes it's important to live with intention. Connect with Jennifer: Website Facebook Instagram LinkedIn YouTube Email Jennifer to request her FREE Content Planner at: jennifer@playmakercoach.com Learn more about the FamilyPreneur Business Accelerator and join today at »familypreneur.co« I'm committed to building an inclusive and anti-racist business. I support LGBTQIA+ rights and the rights of all intersectional identities. I believe that business should be a force for dismantling systems of oppression and actively invest in my own learning to fulfill this role. »Read My Full DEI Statement HERE« Would you like to deliver your own private podcast feed to your audience? Sign up for a free trial today at Hello Audio.

-What has happened to Listener ND since he came on The Codependummy Dilemma and started his 30-day Self-Validation Challenge? - What happens to a codependent when they stop seeking validation from others and start to provide it to themselves? -How can spending 1-10 minutes every evening validating yourself turn into a true change in your external and internal world? In this episode, I check in with Listener ND about the ongoing rewards of his taking on the 30-day Self-Validation Challenge. ND came on The Codependummy Dilemma back in June and was assigned by Marissa to have a “nightly call” with himself every evening to provide the validation he so sought from others. “Give that validation you want to yourself” was the prescription and ND has freakin' done it! He went 30, 60, 90, and how 180 days validating himself. Tune in to hear about all the changes he has experienced and his encouragement that you can have the same if you take on the SVC!  Thanks for listening!  Helpful links: www.codependummy.com/challenge - start the 30-Day Self-Validation Challenge STAT! www.codependummy.com/toolsforhealing - get your copy of The Confiding Codependummy for just $1 a day for the next month (it's $30!).  Want to come on The Codependummy Dilemma? Email marissa@codependummy.com to start the process. Who knows? Maybe you'll inspire another challenge! More deets on today's episode:  We kick things off with a timeline with Listener ND:  -He emailed me to say thanks in late May/early June -I invited him immediately to come on for The Codependummy Dilemma -ND said “Yes” and came on in mid-June.  -I challenged him to 30 days of practicing Self-Validation since he acknowledged that was what he sought in a previous relationship which took a toll on him and his ex. “Why not provide the validation you crave to yourself?” -We checked in at 30, 60, and 90 days. -Now we are here, with ND, after 180 days of validating himself on a (mostly) nightly basis!  Questions I have with ND:       What do you want to say to validate yourself for practicing self-validation for the past 6 months?       How has practicing self-validation improved your relationship with yourself?       How has it helped you improve your relationship with others?       How has this daily practice –which takes minutes-- helped you specifically with becoming less codependent?       What surprising things did you learn about yourself from these nightly check ins?       What do you sense contributed to you being able to start this practice and keep doing it for 30, 60, 90 days, 180 days?       Other listeners have thought about it, maybe started it, stopped and started again. With January 1 around the corner which is the perfect time to try out the self-validation challenge for 30 days—what can we say to them?       What about the listener who has thought about coming on for the codependummy dilemma? How has your decision to come on created a ripple effect in your life?       Beyond listening, coming on the podcast, starting the self-validation challenge – what other things have you done that have helped with your healing from codependency that you can share with us?   Any favorite episodes, guests or topics you'd like me to revisit? Any topic you'd like to request I cover in the 2nd year of the podcast? Thank you ND for coming on and sharing how the SVC has helped you. Girl, hop on it and get yourself the challenge: www.codependummy.com/challenge Marissa's info: www.codependummy.com @therapywithmarissa on IG www.therapywithmarissa.com Help keep the lights on here: https://linktr.ee/codependummy