And welcome everyone in the room and over zoom I'm excited to continue our McLean ethics series as I do at the beginning I'll just remind you where we are we are finished our fall and our winter quarters we have moved on to our spring quarter and Dr Miller is our third talk of the spring quarter. Next week we're going to have a panel of our surgery colleagues coming to talk about kind of the state of women in surgery and followed by one of our OB gynecology colleagues talking about gender equity and family planning. Dr chore and then followed by the last week in April, the President and CEO of Morehouse Medical School is coming and Dr Valerie Montgomery Rice to speak with us so looking forward to the upcoming events. But mostly I'm excited to welcome Dr Pringle Miller here today. I'm going to go ahead and introduce her before she gets started with her talk so Dr Miller is a board certified general surgeon in general surgery and hospice and palliative care medicine. She practices acute care surgery and works as a hospice physician and is provided palliative medicine and clinical medical ethics consultation. She is an adjunct lecture for the UIC COM ethics curriculum. Dr Miller received her medical degree from Pritzker here 1997 completed a general surgery residency at Santa Barbara College Cottage Hospital and returned to you of Chicago to complete her fellowship in hospice and palliative medicine, and then McLean Center in 2017 and Dr Miller is an associate member of the American College of Surgeons Academy of master surgeon educators, a former and a former American Academy of Hospice and palliative care medicine Hurst scholar. Her clinical and research interests include integrating palliative medicine and clinical medical ethics into the care of the seriously ill or injured surgical patients, and this passion has led to becoming a founding member of the surgical palliative care society. Next to this lecture series Dr Miller is an advocate for justice, equity, diversity and inclusion in medicine and surgery as a founding member of times up a health care and a founding and executive director of physician just equity. Dr Miller is a 501 C3 organization that exists to support clinicians experiencing worse workplace injustices championing championing balance, balance resolution while aspiring to facilitate institutional culture change. So we're excited to have Dr Miller with us today please welcome her. Good afternoon. It's nice to say afternoon. No. I'm not really interested in six and seven o'clock in the morning conferences anymore so this is a nice civilized hour. I appreciate everybody being here and everybody on zoom. This place brings back a lot of memories, as you heard I was a Pritzker student, and then a hospice and palliative medicine fellow and an ethics fellow. So I spent a lot of time in those seats and not once have I actually been here so it's a privilege and an honor to be giving the talk today and thank you to Dr Euler and Aurora for inviting me to contribute to this really impactful series. So I was told to project the CME slide. And because this is CME generated talk, the two objectives that I put forth were to examine the nature of workplace injustices and describe a mitigation strategy for the targets of workplace injustices and I'm using the phrase workplace injustices to really include bullying and harassment, discriminate discrimination and retaliation. So keep those terms in the back of your mind with regard to the work that PJ E does. But the other part of why I wanted to give this talk and what I hope that you take away from this top talk is uplifting the the rights of persons. It's core to ethics, respect for persons and other core principle and ethics and upholding people's personhood. And part of what I'm experiencing personally and with regard to the work that I do with PJ E is that people are very much undermined in who they are as as people. And so we're not really doing a good job within our professional spaces to respect the people that we're working with. And I think that until we can do that with our colleagues co workers and obviously with our patients. We're not going to move closer to Jedi, which, as you probably all know stands for justice equity, diversity and inclusion. So among the lines of upholding persons and respecting persons, we have to think about testimonial authority so I'll touch on that a little bit, which means that we all have the right to our own narrative, and narrative is an important part of ethics as well. And certainly clinical medicine, we seek the narratives of our patients but we also have to seek the narratives of each other. It's such a trickle down effect how we apply our interest and curiosity to each other manifests and how we do that with our patients. And also in terms of our reality, we each have a different reality, but that doesn't mean that our reality discounts anybody else's reality and what I'm observing also is that we're not really upholding each person's individual reality with regard to our interactions and and making sure that we give space to that and credit to that. So, if memory serves this fellowship focuses a lot on how we ethically treat patients. As I said earlier how we treat each other impacts how we treat patients and now there's been an accumulated amount of data with regard to how the civility or in civility that is manifest within teams and discourse has an impact on how patients are safe and also heard and valued and treated in the workplace so this is sort of the call to action that we're all stakeholders and cultivating a just and civil workplace that respects all persons. So I guess I couldn't really have an ethics talk without sort of getting back to some of the fundamentals. These are really basic things just that we have to hold in the back of our mind that ethics aims to figure out what the right thing to do is what the best course of action is it helps people decide how to behave. How to treat one another and what values should be paramount and prevail and bioethics has helped transform the practice of medicine as we all know as you studied the sort of trajectory of the text over the course of your fellowship and policy and how we deliver care. So, in thinking about what I'm observing again and this is through the lens of the work that I do with people who are violated within their workspace. I thought about the Belmont report and respect for persons, how individuals should be treated as autonomous agents and this isn't just obviously for research subjects for which the Belmont report was formulated I mean again I'm trying to extrapolate that. But if we think about our behavior and treatment of patients really has to extend to the broader community of healthcare workers and physicians and surgeons. And of course the four principles here that we're all very familiar with need to be applied to how we treat each other, not just how we treat patients. The article that was written by one of the speakers that preceded me Dr. Jackson and Dr. mellow was very impactful to me in 2020. It was sort of in the cusp of time, when I was doing less clinical work and starting to think more about advocacy work. And so the title of the article standing up against gender bias and harassment, a matter of professional ethics. I felt was very resonant. And some of the things that they say in the article are that the institutional constructs that we see on the walls that we hear in our trainings and so forth, only go so far, right. And we have to be able to apply those things as individuals within the subsets of groups that we function in. And so the institutional way of looking at professional ethics or professional code of ethics and so forth. It's just not enough that we each have to take personal responsibility for the way that we treat each other. As I mentioned in this article, peer support. They also mentioned in this article about accountability. And I think a form of restorative justice, which is that if somebody is been harmed, they should have a mechanism to express that but then there should be also a mechanism for them to be made whole. And I think that we do a very good job of that. And some of the systems that are in place for medical doctors. You can report, it can be very incriminating if you report, you may actually become the subject of an investigation yourself, if you're the person who is reporting, rather than the person who is the perpetrator. So we still don't have really good mechanisms in place to protect the reporters and to investigate in an unbiased type of way. And basically the bottom line also to their article was that if you as an individual see something that isn't right, you should say something, and so that's a call to action with regard to the solidarity that needs to take place. And some of us being shared stakeholders and John Lewis said this way before they did but when you see something that is not right night fair, not just, you have to speak up, you have to say something you have to do something. I'm going to take a drink of water. So why did I title the talk in civility is unethical. It's because I'm seeing a lot of the behaviors that are at the lower aspect of that diagram disrespect micro aggressions discrimination bullying harassment violence I'm sure all of you have read many papers many papers have been presented within this forum. About the harms and the behaviors that people are experiencing with the workplace and so I started to think about with all of the ethics that we know about. You know, why haven't we come a little bit further in civility within our workplaces. My perspective is that skewed, just because I interact with a lot of people. In terms of the propensity and the pervasiveness of these things so I am making the connection that in civility is something that we have to think about within an ethical context and that these behaviors. We need to aspire to respect for persons diversity equity inclusion belonging and excellence and some of the arguments of a lack of excellence, due to a diverse population of physicians is something that is not a good argument. I'm not going to be able to touch on that but I hear that a lot, especially in my communications with American College of Surgeons, which is, you know, unfortunate. So in civility is unethical and we must embrace the shared reality. And so I mean it. Okay, is it sputtering. Oh, oh, sorry. Okay. Okay. Can you hear me better now. Is this better. Okay. All right. So we're going from in civility is unethical to the idea that we need to start focusing our behaviors not just on the welfare of patients but on the welfare of each other within the workspace and how that will also benefit patients. And our shared reality so the reason I say that is from time to time I watched this debate that James Baldwin did versus William F. Buckley at the Cambridge Union it was in 1965. And then he's talking about how, well the question was, is the, let's see, is the American dream at the expense of the American Negro, and, and that is kind of a far reached topic for, for this but he was saying that he felt awkward in talking about the answer and because he was at the time considered an American Negro and his perspective of whether America was built at the expense of the American Negro was very different from Buckley's. And so I am thinking that as we talk about ethics there's a tension, there's usually you know that attention that we identify and I'm proposing that part of the tension that exists is that we don't collectively think of each other's realities. In the same light. Now we don't share the same reality but we can uplift each other's personhood in our individual realities. And if we were to spend more time in curiosity and interest with each other I think it would let make us feel less that we are different from each other and othering each other. So, unfortunately I don't know if Dr peek is watching on zoom, but one of the things that I remember very vividly about being a fellow was her ability and her courage to talk about very personal and violent things that had occurred in her lineage. And to some degree how that violence and disparity impacted her to do the work that she's doing, right. So I'm taking it from a mentor and a woman that I respect quite a bit to kind of reveal a little bit of my underbelly. My vulnerability as a person, what my personhood looks like, which is more than the credentials of the introduction obviously, so that you have a sense of where I'm coming from with the work that I'm doing. It's, it's informed by not only my genetics, but my phenotype and my genetics, and the input that I've had from the world around me. I am who I am, and all of us are who we are, and that should be enough. And we should be respected for that. So, this was a surprise to me, but just by way of genealogy and ancestry. I'm 69% European 50% Jewish and good pay sock to my Jewish brethren. And 4% Nigerian 4% from Molly you can read the percentages but basically 31% of my genetic pool is from Africa, and the other percent is European now I don't know who would think that by looking at me. I don't know. So, the point of that really is to say that we may think that we know who people are by looking at them, but we don't have a clue who people are by looking at them. We really have to dig into the weeds of people to understand where they're coming from what their experiences have been. This is a historical document of the Mississippi census in 1920. And this isn't the right slide but sort of the second, the second group of people here is my paternal grandfather and his wife and his four children who were living in Mississippi, they actually owned land in Mississippi, and then they migrated to Chicago at the time of the great migration, because of the injustices that were happening in Mississippi so I am the descendant of enslaved Africans who survived, and who went from Georgia to Mississippi to Chicago. I'm also the descendant of Holocaust survivors. So, my mother was born in a teeny tiny town called shank lengths felt not too far from Frankfurt. Her family is mentioned in this book, the stories. So the translation of that is the stories of the Jews, the Jewish community in shank lengths felt. And the picture there is a photograph of my maternal grandmother as a little girl with her fraternal twin boys, and my great grandfather, great grandmother in front of their metzger I, which is a butcher shop. At the time of the war, they left this all behind to survive, and they immigrated to New York so I'm the descendant of two people whose families and my mother most directly took an airline ship liner across the Atlantic Ocean, and landed with her family in New York. This is a photograph of my father and his birth certificate so he was born to a woman who lived just a few miles away from this campus, and yet my grandmother, my paternal grandmother was not able to deliver him here at Chicago lying in. She traveled from Hyde Park to Cook County to deliver him because that's where Black people delivered their children at that time in 1930. And the reason why I presented this was because if you can see where it says no up here. There was a box at the time that asked the question, is this child legitimate. And it says no. And he was illegitimate at that time, because there was no identifiable father figure that was put on his birth certificate so the government. considered him illegitimate, very stigmatized obviously. And that illegitimate black baby boy grew up to be the first art professor at the School of Art at the University of Washington. So we all have tremendous potential, even though we may not start out with the most tasteful and or supportive systems. So my mother, this is her in Germany the same building that they owned in Schenglenxfeld that's her as a little girl. She's straddled by my great, my maternal great grandfather, and my grandfather, my maternal grandfather and grandmother are here. And this is the little girl you saw in the previous picture with her fraternal twin brothers. And fortunately that enclave of my family did survive the Holocaust, but at a great cost to them and not everybody was able to to get out. So black boy from Chicago meets Jewish girl from Germany in New York. They decide they want to get married, and they end up being the poster children for an article in the New York Times called race sex and the Supreme Court. And at the time that this article was written in 1964. There were 22 states in the United States that still had anti misogynization laws. And I am the baby in that other photograph here. So I was already born. And I could have been this is a Trevor knows lines I'm going to steal it give him credit. I could have been a born a crime. If I had been born in one of those 22 states. Fortunately, that wasn't the case. My parents were able to conduct their marital relationship out in the open, as you can see they're sitting on a Central Park bench. But at the time that that article was written the author Anthony Lewis and the editors didn't want to reveal who they were by name because they thought it would be too dangerous. And subsequently in 2017 that other image here is coming out of a book that the New York Times put together. That was supposed to give voice to the images over the decades that took place in the New York Times magazine of people who were not named because the issues that they were involved in were too fraught to name them. So, again, I tell you this because I think it will help you understand how I approach the work that I do, and how ethics is extremely important to me, ethics and doing the right thing so in the context of that, moving forward to the next generations I'm the proud mother and mother-in-law to those two women and their new baby boy my, my grandson so life goes on. I graduated from Pritzker in 1997. To my knowledge and I'm hoping Dr. Aurora will help me do some historical deep dive into this I think I was the second woman of African descent to enter into the surgical match and in 1997 that sounds kind of surprising to me. But I think that's true I was one of a few self identified black women of course I'm half black but in that category, as was said I went on to cottage hospital to do my general surgery training, oh why is that bar. What do I do to get rid of it. It's been there the whole time. That's unfortunate. Yeah, sorry, I wish I'd noticed that earlier. So I went to Santa Barbara in California, I figured you know if I was going to be a surgery resident before work out restrictions I might as well go someplace where I felt like I was on vacation all the time because I sure as hell wasn't going to have any vacation. And I probably wasn't going to see the light of day. So, I thought okay you know cottage Santa Barbara that sounds like a good idea. It's an aggressive right. Yeah, California Santa Barbara. So I went and found out that as I graduated as a chief my co chief at that time cottage was a small place for surgery to have as graduated we were the second and third women to graduate from surgical training in 2002. You know that's not that long ago. Cottage has been open to training residents since 1921, and then officially became approved as a surgical residency through the American Board of Surgery in 1944. There has not been a single black resident to matriculate or graduate from cottage since me. Okay, so now how do I advance the slide since the bars. Okay, I got it. Sorry. Okay. So moving forward, you can see what the landscape looks like. I take a job in California progressive place Marin County so I thought, and I'm the first female surgeon to work at a community hospital in Marin County California. There are announcements you see the newspaper article, the Nevada advance writes an article about me introducing me to the community and the first sentence of the article is Dr Pringle Miller. My name was misspelled a black woman married to a white man. We're talking about 2002. So I was, it was a true statement, I was married to a white man at the time, but I was there on business, I was there as the surgeon to bring new minimally invasive laparoscopic techniques. Dr Angeles like this I was doing minimally invasive thyrathyroids. I was doing things that I had been trained to do. And they wanted to focus on my race ethnicity and my interracial marriage. It was devastating the paper article came to my office. I was just felt sucker punched you know I didn't know what to do. It pretended how the next few years of my surgical life would go. And this slide sort of represents a rip because it really disrupted everything that I had put into motion you know I had thought that at the end of the five year training program. I was Scott free right like I got through residency, my family's intact.  At that point, what I realized now is that I was being subject to what I think is a good way to frame this is know your place aggression. You know, you are a person who is here because you have the credentials but you need to know what your place is. And so, I don't know if you remember when these bias catalyst things came out, but I was kind of enamored with them and so as a, as in the bias connect you become a cold aggressive bitch, when actually, you're a focused assertive leader. That's how radically different people can see you. And I felt the repercussions of not being seen for what I was trying to do, which was bring minimally invasive techniques to the community to bring diversity to the community, not just gender but race and other things and it was really in a very negative way. I was made to feel like I was the problem I was labeled a disruptive physician. And that was sort of when the gaslighting began and so I'm sure you're all probably very aware of gaslighting. I'm commonly understood to refer to the intentional manipulation of someone else's account of reality, and it's considered a form of psychological abuse. I felt like I was a major problem, because that's the way I was made to feel in the workplace.  As a surgeon, I won't say all the behaviors that surgeons learn are good behaviors but there are a lot of exemplary behaviors that I was executing as a freshly mended surgeon and it was blowing back in my face in a very negative way. There was no language at the time. Okay, so that was 2002 to 2005 it's taken me till now to really start to understand what I was being subjected to. And that is why I feel more empowered to move the needle forward to help people develop the language and the understanding of how they are looked at in the workplace and how we need to treat each other respectfully. And this came out in in press gaslighting and academic medicine where anti black racism lives and it's very apropos to my experience. And here we are again with sort of institutional betrayal as a phenomenon. Jennifer freed has done some amazing work with regard to institutional betrayal. But in institutions of holding anti black racism by explaining it always is another phenomenon thereby betraying black members of the organization who bring forth claims of racism and good faith and I would say even though this is a paper about racism, you know we could say the same thing happens for women who are bringing claims about sexism. And the kind of MO is to explain it away. As an interpersonal conflict as though the person who is describing this is really problematic, you know they have a personality disorder, they are now equipped to handle their environment. They don't fit. There are a lot of different things that people say and tropes that people use to try to take away the responsibility of the environment to treat all people respectfully. So it wasn't until 2006 that I and I saw this article. And I want to tell you her name I don't know that any of you have read this article. Okay. So this is Dr and mana Lumamba, cause Sango, and she wrote this article in 2006, it was like a news week article.  It makes me like a ton of bricks, because I felt that way. I was like, I'm going into these workspaces, and I have my badge and I'm wearing my white coat, and I have gray hair and you know I can talk the talk. And yet, they want to know where I'm from. They don't want to know what their diagnosis is they don't want to know what I think that the might you know the surgical options would be what the best option for them would be. But it put it on the map for me that I wasn't the only person having this experience. It brought me to doing more work in the space, collaborating with women, particularly women in surgery because that's where I come from. And I had been recognizing that there were so many women in my community who had also had experiences in the surgical world that were less than aspirational and had really stunted their ability to be all they could be into to do all they could do. And probably along the line really jeopardizing the best care for patients, as we know that there is a trajectory between the lack of diversity and the care of patients and so I had pitched this idea to the narrative inquiry and bioethics about how they should do a symposium on the experiences of women in surgery. And they thought about it and they was like, well, but maybe your experience is just kind of isolated. And I said, I don't think so. So they put out a call, and they got about 3540 responses of an abstract of people saying what you know their narrative would say. And they were ecstatic, and I was completely underwhelmed because I knew that there were hundreds of women out there in surgery who had experiences that were worth talking about but most of them didn't want to share them they were ashamed embarrassed. They didn't want to bring reprisal onto themselves and so unfortunately you know we got we got enough narratives to create the symposium, but it wasn't the show at the show that I thought it would be. And I want to thank Dr. Angeles because he contributed to this symposium by writing a narrative, not a narrative a commentary, the value of speaking up, and I appreciate you doing that. Thank you. So I encourage you all to check out that symposium, following that the narrative inquiry and bioethics decided that they wanted to do another symposium from the voices of people who are underrepresented in medicine not just physicians but also other allied health care professionals and this symposium came out in which I was actually a narrative contributor with the article entitled racism unplugged. But what I'm really trying to say here is that there are a lot of people who we don't know very well, either we don't take the time to really understand who they are. And we don't really take the time to understand what is happening for them in the workplace. They're bringing their a game, but they may not really have a chance to, to express that to their fullest capacity. So I met Dr Aurora. Five years ago. Yeah. Okay. Okay. We came together this you probably recognize that space in the CCD we came together through a mutual interest in times of health care, and the sticker of times of health care is on your laptop. It doesn't exist anymore, but I have to say that that was one of the most empowering times in my life to hear the research, the work that many of the speakers that you've had the good fortune of hearing speak about, and it catapulted to recognizing that there needed to be a place for clinicians to go who needed strategic help with their workplace conflicts. So I'm kind of getting to the last bit of the talk that has to do with the work of PGE. This sentinel report came out at about the same time we were all talking about it. It was published in 2018, the National Academies of Sciences engineering medicine, sexual harassment of women, climate culture and consequences. Very impactful report for just the research the data, the overwhelming preponderance of mistreatment of women in the workplace. And this nice photograph of how a lot of these behaviors are under the surface. They're not things that you can necessarily see. And that there are many, many other, you know, things that we wouldn't necessarily know about, although sometimes we have a firsthand view of indiscretions that are happening. The sixth recommendation in the report was support for the target. And since I had been as I had mentioned, very much I felt targeted over the years. And being pigeonholed into being a person who I wasn't. Being roadblocked and doing the things I wanted to do. It felt to me that that was an open door to create an organization that would be supportive of individuals who were being mistreated in the workplace. And so out of the times of health care experience, even though that didn't run fruition to fruition in my mind. It did inform me it educated me it got me connected with a lot of heavy hitters in the space and made me realize even more so that there was a gap in support. And so this is the, the front page of our website physician just equity as Dr Euler said our slogan is championing a balanced resolution and underpinning that of course is ethics. Our mission is to provide peer support to physicians and surgeons in the United States who experience workplace conflicts through education research empowerment and advocacy championing a balanced resolution while facilitating institutional culture change that optimizes the organization care, because my learned opinion was that organizational initiatives were not working and organizational professional societies were taking a very backseat to individual persons issues that there was no place for people to go to get help. And our vision is dedicated to achieve achieving I will have to edit this justice diversity, equity and inclusion in the medical profession we have personal knowledge and experience with the investment and hardships that lead to attrition and the tragic loss of talent from the profession to accept the current culture of medicine is to deny a safe equitable and dignified workplace to valued clinicians and withholding higher quality patient care. So these are just our four pillars support research outreach education, and each of these has, you know, sub themes but basically in our support effort we do collect data and you'll hear more about that. So I look at us as a little bit of a think a mini think tank and research center, which is hopefully going to contribute to the literature not just in saying oh yeah we know this percentage of surgical residents experience this and this, but what actually happens to those people. Work. Do they have to jump, jump from job to job because each job is telling them they're not a good fit. You know, are we really harnessing the investment that we've made into these doctors that we've that we've not only have they graduated from school but now they've finished their training and they're not working like they want to be working but they're not working. That's not okay. So that's the research part that's that's where I hope PJ will continue to add information that's data driven information to the to the reach research component of what is already out there. Each has to do with forming partnerships and education really has to do with a library although people can access things very well, but also the educational workshops that we do. So, as you know PJ ease of 501 C3 organization, we were founded in October of 2020, we opened up our doors to peer support in February of 2021 so we just hit our two year mark. Thank you, Dr. Jackson. We have 40 people involved in our collective so we call ourselves a collective there are 40 physicians and surgeons in the collective that provide this voluntary peer support to people and I will tell you a little bit more about how that peer support works. Since February of 2021, we've had 104 individuals reach out for peer support. I think this is just the tip of the iceberg because people don't really know about us, but hopefully this will help. We're starting to get some more recognition and visibility. We've had eight publications in which we've either been the primary author or been mentioned so we've been mentioned in a New York. Sorry, not in New York but a NBC News article about a colorectal surgeon who's been blackballed from colorectal surgery and other articles in various venues and then we've hosted seven webinars co hosted I should say with Amwa. So here's just an example of some of the webinars that we've hosted we started out with a webinar that was called know your rights because it's really surprising how many physicians I mean maybe not so surprising we were not lawyers we. Some of us are not lawyers. Some of us are lawyers, but you know we aren't really schooled and what might be called some of the hidden curriculum, you know what are the things that we need to know as we navigate our workplaces, so that we're treated respectfully and with so we didn't know your rights webinar we did a red flags webinar, which really focused on how to identify when the walls are starting to close in on you, you know when when something doesn't feel right but you can't quite name it but you know that you're not being treated the same way you know that you're not being offered the same opportunities. We did another webinar, being a better ally, which gets back to that solidarity and how can we be upstanders in our workplaces so that are underrepresented colleagues and the people that are getting picked on are not an isolation when they're getting picked on. And then recently we did a PHP webinar, because unfortunately the PHP's are misrepresented and oftentimes used as a weapon to get people out of the workplace, even though they don't have substance use disorders and the upcoming webinar is peer review, which is also sometimes weaponized against people who some people just don't want in the workplace, but there isn't really anything wrong with their, their competency and their ability to care for patients. So this article recently came out in surgical clinical clinical erectile surgical clinics and the reason I put it up here is because I wanted to give you guys a flavor of what people say in their contact us message that starts the conversation about them having peer support. So we are not really in the business of helping students but we have had students reach out to us and we didn't feel like we could say no. But we are mostly in the business of helping residents and people in practice but let me just read to you these three blurbs so you get a sense of what people are experiencing. I'm a fourth year medical student facing retaliation for reporting sexual harassment. This person was on their vascular surgery rotation as a, as a student and actually was interested in surgery as a, as a career choice in the match. I'm interested in any help you all could provide as well as working to change the culture of medicine into a safer more supportive environment. She was terminated dismissed from medical school for credits from graduation and has not been able to reenter. There is nothing wrong with her performance. The resident example here. I'm a resident physician I was sexually harassed and subsequently sexually assaulted while operating on a patient, then retaliated against for reporting it to independent investigators confirm mistreatment of women and retaliation by the university, including the ACG me investigated and sanctioned the program. However, the university and program refused to correct my record seriously harming my chances to match into fellowship and future employment. These are not isolated incidents. This is happening to people people that we see in the workspace are struggling with these sorts of issues, and then the attendings blurb was I am an early career surgeon who is being blocked from working at any US hospital in the country due to discriminatory acts by a former employer. This is a pretty hefty double down effect. That is the antithesis of any type of restorative justice. And this is what we need to work on to prevent the sort of thing from happening and or once it's happened that there isn't justice for people who have been violated. It's not an old schematic but it gives you an idea of how we do our peer support. We get a contact somebody refers a person, they contact us through our website, or social media. I get that inquiry, I confirm that somebody wants to have peer support, and then I start. Well, I send them an intake form. That is what they filled out with the with an alias, and whatever they want to include on the, on the intake form but it really asked demographic questions so we can. So we can collect demographic information, and then it asks more qualitative and qualitative information about like you know what is the thing that's happening to you that you're reaching out to us for. And what do you, what are your expectations of how we can help you, how do you want us to help you. So the idea that intake form I put together a peer specific team from the PJ E 40 person collective. And I pick people deliberately based on what this person's issue is, and who I feel is best on the team to address their issue, we decide on a time in a day. And I think for one hour over zoom, the peer who's sought our support is assigned a case navigator, or a peer navigator really but that's taken from my experience with cancer care and having a nurse navigator. So there's a lot of application. Both with regard I think to my surgical training and doing this work and especially my palliative training. To learn more about how to listen and what goal oriented care looks like and that sort of goal oriented support is very much applied to our teams within PJ E. So we come up with a strategic plan. As a way to navigate the workplace conflict, and then the meeting ends, we have the peer navigator follow up with that person with whatever frequency they both decide is right for them. And, and then the peer navigator gives information in our platform where we communicate with each other if the peer needs more support, another meeting or some type of advocacy letter or whatever the case may be. This is one of my prouder things that has happened in the, in the near past, which is that the Journal of General internal medicine decided to publish our 700 word research letter, which describes our pilot experience, since offering peer support to the first 35 people that we supported between February of 2021 and December of 2021. So our first 11 months of experience. So as you can imagine the introduction just talks about the things that are being identified as barriers to working in the workplace, the need for peer support. So it was an IRB approved study. It was a de identified survey study that captured both demographic information and then qualitative information about how people found the support. So as you can imagine, we had a preponderance of women. So, I think I don't know if you can read the, the chart there but 89% of the people that presented. And that's like 35 people and were either women self identified women or non binary and then 11% were men. The percentages of white and Asian were similar 37 and 34 respectively and black or African American was 16%. We had about 34% say that they identified with a religious minority, the degree demographics are laid out there. Most people had an MD, but we had some dual degree people with MD PhDs and MD MPH is and then a few do's. And then of course the students did not have medical degrees yet. Most people were trained in the United States but some people had either med school in a foreign or an international place and or some form of their training. And then the split between learner and practicing person was about 5050 as was medical specialty versus surgical specialty. I want to read a couple of the narratives, or I'd say the reviews that we got for performing the service. The qualitative aspect of the study that's here is that the people's feedback went into a strategic support theme, an emotional support a resource provision theme, and what they thought of the importance of the work. So just by way of giving you a sample. In terms of strategic support the members are knowledgeable on practical interactions with attorneys ACG me and sponsoring institutions. The entire process felt safe and supportive I was given concrete useful advice on strategies I could use to move forward. I was able to support, they made me feel seen heard and believed. I no longer feel alone and isolation is really one of the things that's most devastating to people who are experiencing workplace injustices, knowing that someone cares, and has been through this is huge for doctors. Many well meaning people would try to help, but they would ask questions that were analog analogous to why are you failing. Whereas this group felt like they linked arms caught me and helped me move forward resource provision website is informative and well made. PJ is provided resources legal and academic for me during this journey, as well as peer support from these women who have walked my same path now we're just not a women's organization. We do have men involved in doing peer support. And then, I think importance of the work it is about time and organization like PJ has come to the forefront women underrepresented people in medicine and other physicians in protected classes have been systematically discriminated against by their colleagues and organizations without significant protections or resource resources physicians who are targeted and attack need a team on their side to help navigate dangerous territory. This is an incredible this is a second one this is an incredible service to humanity doctors give their entire lives to the cause of saving and helping human lives hospital administrators and leaders chose to choose to annihilate these very doctors who speak up against broken systems instead of fixing the system. PGA totally gets it and as a life support for physicians who would otherwise be destroyed. Oh, there you go. So, um, so I'm winding down here. The help Senate committee who is chaired by Bernie Sanders put out this letter, which was brought to my attention by a colleague who's actually also a Pritzker graduate Pritzker alum, seeking information from healthcare providers on workforce shortage and ways to mitigate the workforce shortage. And so, we are not in a position to lobby as a 501 C three, but we are in a position to advocate. So we did a letter of response to the Senate help committee. This is a fraction of the members of PGE who sign this putting together. I think a pretty good letter as to why, or as to the fact that we are losing people who are talented and trained to nefarious things in the workforce, which is not helping the workforce shortage. And so even though we spent a lot of time thinking about the pipeline, we really need to think about the people who are already trained, educated and trained. And so the contention is that if we could enact systems safer systems for people who are suffering from workplace injustices, we wouldn't lose as many people. And that might actually help with our workforce shortage is not going to solve the whole problem, but it could help. So this is one of my last things I want to say marginalized groups and their allies need to be equipped with language that helps them to resist absorbing dominant assumptions that are designed to silence and shame them. And I know that aggression comes their way, because they are successful, not because they have done something wrong. And I am a fan of Polly Murray, who has the quote surrender to none the fire of your soul. So I'm going to read the QR code for the for the peer support research letter, if you want to take a shot of that and read it. It's also my contact information. And the Twitter handle for me and physician just equity is at equity docs. And then our 2022 newsletter has some good information there's links to some of the websites, or some of the webinars that we've done. As well as some of the articles that we've been mentioned in. And see me again. Thank you for that amazing talk and I have some questions on zoom and if anybody'd like to put questions on zoom will do that I have one question. Yeah, stay here. Yeah, because we'll switch the mic back and forth I'll repeat the questions if we get them from the audience. And my question is really about the peer kind of support and how do you recruit and support and train those people and you know how did that, how did that come to be. So it initially came to be that I was just in a community of people who were pretty outraged and wanted to do something. Like with a lot of advocacy, you know, you identify a problem and you want to fix it you want to do something to support people so my immediate community of PJ E were people who had similarly experienced things and had a lot of knowledge in their journey to combat the injustices. And so what I like to say is that we harnessed our collective wisdom around how to navigate these things now it's not a perfect science and every system is different. But there are some basics that we can fall back on and so the. So that just was the beginning and then it became a snowball of people who heard about what we were doing who's like I want in on that I mean I have a lot of trauma and I need to do something with my anger and so why don't I general my anger into something productive. And so that that is what we have done. We do some training. It's a little bit of a surgical see one do one teach one model. And maybe as this, if it takes off a little bit more will have some more sort of formalized training modalities for people who are peer supporters but but mostly people who want to do this are our folks that have been there, and they're good listeners and they want to hear from people and they want to make people feel heard and validated and and also I mean we're not just pushovers right you know we we listen for things that might be red flags and all of us have things that we can work on but this usually gets skewed in a wrong direction. I read one question from those. This is also about not the peer supporters but the people that contact you. And I think the question is, yeah, no I was with the supporters I was asking what I asked you with this one's different. And this is, do you connect the clinicians who contact PJ you with each other. I think, you know, he, they're a span of peer support and those people supporting each other and I don't maybe there's some kind of rules around their privacy but I think they're wondering if they can get that contact you and get, get, you know, supported today, are they connected. Did they then become peer supporters. Oh, oh yeah. So we haven't done that. And actually that's a point of conversation whether there should be some other larger network of people like, you know, a Facebook group or something where they can come on and and, and exchange information we haven't done that yet it's kind of a work in progress, but anyone who is interested in having conversation with anyone in the collective can certainly access them if they want to but the peers themselves and sometimes peers become peer supporters, and, and so then they get connected that way. So I'll just repeat the question is about the peer supporters are they volunteers and how could we like make that, could we do that at an institutional level, you know, as opposed to a national level here. Right now, the peer supporters are volunteers. Maybe there's a pipe dream in the future that people who spend their time doing this work will get some financial. Renumeration, I will say that people are thriving on giving back. So they definitely get something back. And we feed off of each other. So we're supportive to each other, which is really helpful. The question has a peer support mechanism but it's interesting because it's really geared more towards clinicians who have been involved in a an error, a clinical error. But I, you know, I think we can extrapolate right. So one of the institutional mechanisms in my opinion is that they're biased. And so I don't know how we break the shackles, so to speak, of the bias that exists within systems to really make it a safe space so I think you know one of the things that we have going for us is that we're independent. And people are feeling safe. And mostly, the sad thing is though to your point is that they have seemingly exhausted their institutional resources, and then they have nowhere else to turn. And we're a cheap date. And Dr. Angeles You know, have bones and aspirations. And that is so important. And it also strikes me that regardless of where one is, and what one's vision is, you have the opportunity to do role models. They need role models who are patients, students, residents, whatever. So I wonder if you can comment. Obviously summarized basically we're reflecting on insidility is unethical. And lots of other good words, but I'll let you answer from there. I mean you said it so well I, I've been kind of struggling with all of the ethics around us, and why we are still in this place of people, not behaving ethically, and people being the targets of unethical behavior and like what are we, how do we frame this so that we pay attention. And I think the tipping point for me and that connection was I don't know if any of you listened to Hidden Brain podcast. But Christine Porath is a researcher who looks at in civility. And I, I heard her podcast actually, and she was remarking on so many things that paralleled what I've experienced and what other people have experienced and we had a conversation I called you know I called her it's like, I got to know you got to know what you're doing. And some of her research is really worth looking into so for example. And she has said that the experience of in civility is something that people carry around for decades. You know it's not in the moment and of time when people feel an insult. It carries with them for decades like so that's really dramatic and if you add insult to insult insult over time. That's a really traumatic existence. But in civility hijacks the amygdala amygdala. And one of the things that's interesting about that is in her research. She says that 30% of a person's cognitive capacity can be lost when they are dealing with an, you know, an act that is in civil on civil. And I think we know that because there's other literature that is modeled in the surgical arena within surgical teams and not being able to speak up if you feel intimidated, intimidated, and therefore maybe you know if you saw something that you thought was going to be dangerous to a patient, and you don't feel like you can say something that thing happens to the patient and you could have prevented it. So, and then the other part of that is, you know, the loss of cognitive capacity, if you're, you know, being mistreated in the workspace I mean we can't have that right we all have to be 200% intact when we work with patients. Another thing a part of her research I think that was informative to me is that and this kind of blew me away that 15% of people like within her study catchment are self aware and 85% are not self aware. There are some examples of that you know people who lead companies who do 360 exams of themselves and like have no idea how they are interpreted amongst the people that work under them. And so, we're all a work in progress, clearly, but does that I don't know if that even answers your question. I mean I wanted to put it in a different term so that we snap out of it, basically, you know. Yeah last question and back. So I'll just be bravely where does the sex and racism start and then where do you see the PJ going in the next two to five years. Great questions Dr Jackson, leave it to you. That's a really good one the first one where does attention start, because we are looking at that. I would say that where it starts is that somebody will say something that is not a popular thing to say but is the right thing to say. And that's again where this comes back to ethics, doing the right thing being an upstander being a whistleblower. And I figured out if an underrepresented intersectional type person is targeted before they open their mouth.  Clearly, they're not inseparable. I think that's something like in the narratives that we get from the peers that come for peer support, something happened that came to the attention of higher ups, and higher ups, rather than listening to the thing that happened are turning that thing around at the person in a negative way in a gaslighting way. It's not about them. Does that kind of. Yeah, yeah. I was just thinking if I have more to say about the first one is okay. So the second one, I think where we're going is that we want to continue to sort of what I what I say is provide this, you know, bedside person to person support but clearly there's room for more organizational partnership along the lines of this model. There is room for more political governmental legislative actions. One of the people that I pay close attention to is Lloyd Austin, and how Lloyd Austin. So what is his official title, he's the head of Homeland Security, he's a military person he has recognized that you have to take the investigations of military people complaining about harassment and discrimination away from the commanders, because you can't keep the cookie monster in charge of the cookies, you know, you have to outsource that investigation and that restorative justice from from the you know, from the people who have the to to to lose from from the outcome of an investigation so I am I'm hoping we get a little bit of traction from the letter that we wrote to the Senate help committee, because I'd like to on a bigger scale, to relate to them what is happening in our systems, and how that's counterintuitive to the care that we are trying to give our patients and to population health. I mean we have a plethora of data about health inequities. And we have made strides in some diversity, but the numbers are not enough. It's not enough to have a percentage of this and a percentage of that this really has to do with a solidarity and a mindset with all of us, working together to be who we are, you know, our best selves. Yeah, there's a question on the zoom chat that I want that I want the answer to myself so I'm going to go past my. This is from Dr Linda. Thank you for this important work I may have missed this but I'm curious if your organization plays a role in litigation or somehow protected from such a role. Did you hear that seven. Oh sorry I didn't talk about. Okay, thank you for this important work I may have missed this but I'm curious if your organization plays a role in litigation or somehow protected from such a role. Hi Dr Linda. So, I'm trying to leverage the idea of peer review as a protected space, because a lot of what we talk about is what happens in the workplace. So far I don't know if our organization really has that protection of peer review. I do work with attorneys because unfortunately you know this is another really devastating piece of this is that the learners and the practicing folks, all need to get attorneys to help navigate this, mostly, I mean I would say 95% of the people who we've supported have either already identified an attorney to represent them or or we tell them they need to identify an attorney to help represent them. So, I'm hoping to, and this kind of gets back to Dr Jackson's question you know what does the organization look like in the future I mean I'm hoping to establish a medical legal partnership now that model has already been elaborated on in the literature, but it's mostly as it relates to patients benefiting from doctors, educating lawyers and lawyers educating doctors and being able to leverage the resources of medicine and law to the benefit of patients but that should be expanded to how do we as doctors work with lawyers who don't really understand often what happens in medical culture to adequately represent people. And so that kind of medical legal partnership. I'm hoping is in the future. So thank you for all of you for staying and thank you to Dr Miller for an amazing talk and an engaging discussion. We will go ahead and stop the recording and then ask the fellows to come down to the front to continue personal discussion with Dr Miller so thank you.


Okay, in this video, I'm going to talk about the properties of square roots, specifically two prop. Ah, darn it, I did it again. You know what? I'll just trim it off. Okay, in this video, I'm going to talk about the properties of square roots. Now, I'm not going to talk necessarily what a square root is. By now, in Algebra 2, we should know this. Off to the right side, though, I do have reminders. The square root of 1 is 1, the square root of 4 is 2, so on and so forth. You can see those on the right side. What I'm going to talk about today is the product property and the quotient property. These two properties we use to simplify square roots when we can't take the square root of a number. Okay, so what I'm going to do is I'm going to show this just with number examples, and I know in previous videos I've done examples with variables and with numbers. I'm going to skip the variables on this one. I'm just going to do examples with numbers. Okay, so the product property. Products means multiply. If I want to take a number and I want to take a square root and reduce it, I can actually use multiplication to help me with this. For example, if I have the square root of 50, and now if I look at my list over here, I don't know what the square root of 50 is. I get down here to the square root of 49, which is 7, so I know it's something close to 7, but I don't know exactly what it is. What I can do is I can simplify this and get this down to a nicer, neater number other than just the square root of 50 by using the product property. Okay, so what I'm going to do is I'm going to take 50, and this is what I commonly call take 50 and split it up, okay, split it up using multiplication. So again, product property, split this up using multiplication. So what I'm going to do is instead of writing this as 50, I can rewrite this as something different. I'm going to rewrite this as square root symbol 25 times 2, notice that little dot there, times 2. 25 times 2 is the same thing as 50, so I haven't really changed much of everything. Yes, the numbers look different, but it's still 50 underneath there. Now why would we split it up this way? The reason we do that is because if you look at this list over here, I actually know what the square root of 25 is, okay? So square root of 50 changed into 25 times 2. That square root of 25, I actually know what that is. So that is why we split it up using product, using multiplication, and so that I can simplify it down to something a little bit smaller, okay? Now what I can do with this is I'm going to actually separate these two numbers. I'm going to take 25, the square root of 25 times the square root of 2. This doesn't look a lot different, but notice now I have two radicals, two square root symbols, and now that I've kind of separated them, now I can actually evaluate the square root of these numbers. The square root of 25, I actually know what that is, that is 5, but then the square root of 2, I actually don't know what that is. So if I get down to a number that I don't know, I'm just going to leave it. So this is, square root of 25 is 5, square root of 2 is just going to stay the square root of 2. Now normally when we write this, that would be it, now we're done, I can't simplify that anymore. 5 is as good as it gets, it's out of the radical, I don't need to mess with it anymore. The square root of 2, I don't know what the square root of 2 is, it's this long irrational number, I'm not going to mess with that, I'm not going to split that up, nothing like that. So this is it, this is as good as it gets. I can rewrite this as simply 5 square root of 2. You can call it 5 square root of 2, 5 times the square root of 2, I like to commonly refer that to this as 5 root of 2, just kind of a simpler way to say it. So that's an example of the product property, a very simple example. Now I'm going to do an example with the quotient property. Product means multiply, quotient is then going to mean divide. So if I have, if I'm dividing something, this is how it's going to simplify out to. So for example, if I have 36 over 4, and I'm taking the square root of that fraction. Okay, now there's actually a couple different ways to simplify a flat fraction like this, but I'm just going to demonstrate this using the quotient property that we know. I'm hopefully going to do a couple of different examples to kind of help us out with this. Okay, so 36 over 4, what I can do, and this is kind of similar to what I do with the product property, I'm going to take these and split these up. So instead of taking the square root of 36 divided by 4, 36 fourths, what I'm going to do is I'm going to change this, so I'm taking the square root of 36 on top and the square root of 4 on bottom. So instead of taking the square roots altogether of those two numbers, I'm actually individually taking the square roots of them, very similar to what I did up here. Instead of doing the square root of everything, I'm going to do the square root of the two individual numbers. And instead of taking the square root of everything, I'm going to take the square root of the two individual numbers. Now recognize that 36 and 4, we can take the square root of both of those numbers. So notice that this is going to reduce, the square root of 36 is 6, and the square root of 4 is 2, 6 divided by 2 that reduces down even farther, and that is going to be a simple number of 3. Okay, now there is another way you could have done this, some of you might have already seen this, 36 divided by 4 is 9, and so the square root of 9 is 3. That's kind of another way to do that, but the way that I did this demonstrated that I can separate the two numbers. Another example that I can use would be something similar to, let's use, let's just use a simple example, let's do the square root of 18 over the square root of 2, make a big division symbol there, make a big fraction bar there. Okay, so this is a separate example. Now if you look at both of these, notice that the square root of 18, I don't know what that is. The square root of 2, I don't know what that is, so it makes no sense to separate these two numbers. In the previous problem, we separated both of them, we were able to evaluate the square root, and everything worked out. In this case, it's not that. We don't know what the square root of 18 is, we don't know what the square root of 2 is. So what I can do is I can actually bring these back together. So instead of having two separate square roots, I now have one square root with both numbers underneath that radical, underneath that square root symbol. Now the reason that we do this is now it's actually going to be easier for us to evaluate the square root if I actually figure out what the fraction is first. 18 divided by 2 is 9. So sometimes it's actually easier to bring the two numbers back together underneath the radical, figure out what the fraction is, and then reduce. So in this case, we actually got the same answer as what we got above, which is 3. So the quotient rule, there's kind of two ways you can look at it. You can think of it as either take a fraction that's underneath the radical and split it up, take the square root of the top, square root of the bottom, or you can think of it as, well, if I'm taking the square root of the top, square root of the bottom, I can go backwards and bring them back together underneath a single radical. Couple of different ways to look at it. So those are the two properties, those are two of the properties of square roots, the product property and the quotient property.


Step number one, attack the ball with purpose. Step number two, focus on a specific point on the ball and keep your focus until you follow through towards your target. Step three, control your body. Make a strong plant beside the ball to ground yourself, stabilize yourself and get your upper body. I will send the better in one day soccer blueprint to anyone who comments hashtag soccer on this video. Over the ball to keep your shot on target. Step number four, make a strong impact. Flex your foot, make your ankle strong, your foot strong and keep it strong while you push through the ball. Step number five, follow through towards your target with your foot, your leg and your shoulders. If you like this content, check out the Soccer Success Planner. You can download it for free. There's a link in the description below and for advanced training, check out the Online Soccer Academy.


Hey, John Costano here and we're going to be going over the five golden rules of affiliate and CPA marketing in this video. Now I've made over $10 million doing it. Let's just dive right into this video. First golden rule is cash flow first. Now what do I mean by cash flow first? Well I mean that you shouldn't ever leverage yourself more than you can afford when you're starting to do affiliate or CPA marketing.  There are a lot of free traffic methods out there which you can apply just sending messages to folks on Instagram, Twitter, Facebook, et cetera, LinkedIn and I have a ton of free traffic videos where I talk about how you can get started in affiliate or CPA marketing without spending any money whatsoever. So check out those videos, I'll link them somewhere around here. Now if you do have a little bit of money to start but let's say you have $50, let's say you have $100 and you want to get started in buying advertising and making commissions. Then start with app installs. Start with mobile app installs and you can find a lot of products that you can advertise and earn commissions off of app installs by looking at the top CPA networks such as Affiliati, Max Bounty, Ants for Doe. There's a lot of affiliate networks out there, I have an entire list of affiliate networks that you can check out so make sure you just join as many affiliate networks as you can. Now if you do have a little bit of money then I suggest you start with ClickBank or CPA networks like the ones I just mentioned, Max Bounty, Ants for Doe, Affiliati and ClickBank. ClickBank you can earn commissions of anywhere from $50 to $500 for each sale you make and again it's a fairly easy way to start making money and this is good if you have a few hundred dollars to spend in advertising. The second golden rule of marketing is to not fall in love with any of your ad campaigns. But John I really love cat toys, why can't I just try to market cat toys and make money? Look, some things just don't work for affiliate marketing, some things just aren't able to give you the return on investment of time or money that you put into it so don't waste your time on niches that are just not going to make money whatsoever. Now a random story here is I really interested in aliens and I was spending a lot of time trying to market an alien e-book, an e-book on like aliens and how to protect yourself and all this stuff. It didn't work out very well, I was able to make some sales but I was never able to get that campaign profitable so I mean that was just a complete waste of time. Again, don't fall in love when something isn't working, ditch it and move on. This is a business. The third golden rule of affiliate marketing is just to copy winners, okay? Find affiliate campaigns, find top offers that work, find affiliates ads for them and copy, okay? This takes a little bit of research. The first way to find top offers is to join a lot of affiliate networks and just look at each network's top offers, look at the top trending categories, etc. The second step is to find ads for them. Again, you can Google or search norms, terms around that niche and look in Google, look in Bing ads, look in Facebook ads, look in all of these other areas where people advertise, look at display advertising, look in spy tools. There's a lot of ways that you can find other affiliates ads to copy that are running the top offers. Again, once you find an affiliate ads that's advertising a top offer, just copy them and implement it yourself and buy ads on the same targeting, same landing page, same messaging and you are dramatically lowering any risk that you have of losing money because you're already starting with a winning gold nugget and you're already starting with a gold vein because it's a top offer that you know works. This is how I got started, this is how I've done all of my affiliate campaigns, frankly, and it has, I've been successful in dozens and dozens and dozens of different niches from weight loss to testosterone to skin care to survival to insurance to mortgage to refi to investment to biz up all of the above. I've always started by doing my research on the top offers by finding other affiliates doing advertising for them and by copying them. And if you want to learn more about my research process, it's pretty intensive. You can check out my number one income method below, which is a link that will take you to learn more about my training course, the super affiliate system, which is where, which is a very in-depth, very boring material, not boring material. I think I make it exciting, but I go in-depth into my step-by-step process and we've created multiple millionaires that have just followed in my footsteps that have gone through the process that have learned affiliate marketing the way I do it and have made a lot of money doing so. The fourth golden rule of marketing is to have a big picture of marketing in mind but to have laser-like focus on the niche or the category or the product or the offer or the traffic source that you are advertising on or you are using as a message platform to get information out there. Now, an example of what big picture means is big picture is understanding the basics of marketing. Now, one of my favorite books to learn, really the basics of marketing is this book by Drew Eric Whitman called Cashvertising. It's a very engaging book and it gives you very tactical step-by-step examples of how to actually do marketing in the real world. Another good book that gives me a lot of ideas is called Magic Words That Sell. It's by Ted Nicholas. There's a lot of great books out there, but what I suggest you do is understand the big picture of marketing, understand how it works, understand how to do copywriting and all these other aspects of marketing. And laser-like focus comes into play when you're doing a particular offer or niche. Understand maybe there's seasonality, okay? Most marketing in the affiliate and CPA world works fantastically through the months of January through March because of the new year but understand that some niches, it's very different. In some of the e-commerce niches, they do better towards the end of the year. Some other niches do better in the summer. Some niches like tax prep and whatnot like Quicken Loans, et cetera, all the tax stuff work way better around tax season. Understanding the peculiar... Understanding the peculiar... Peculiar... Peculiarities... Understanding the peculiarities of, if I can pronounce that word, of your particular niche helps out a lot. Now, an example from my own marketing is once I kind of pivoted from just marketing health and wellness products as an affiliate to marketing some of my own products in the business opportunity space, I was used to using fear angles. Fear angles is what sells weight loss pills. Fear angles is what sells skincare. Again, when you're selling skincare, you say things like, don't, you know, are you tired of looking in the mirror and recognizing your own mortality by looking at the wrinkles on your face? Okay, maybe I didn't get that intense in some of my ads because they would have been banned, but, you know, I walk up to that line. Or another example of a fear angle would be for the joint relief niche. An example would be, you know, are you worried about going down the stairs at night that your leg will just snap in half because your bones are so brittle and you'll fall down the stairs and die? Okay, that's another pretty intense marketing angle that would work, but again, that messaging wouldn't necessarily be approved by ad network. So you gotta kind of backtrack that a little bit. So moving onwards, going into the business opportunity space, I was used to using fear angles. Maybe I would say things in my advertising like, are you tired of waking up to an alarm clock each day?  Not making your parents proud, but those angles don't really work in the business opportunity niche. People want benefits. People wanna know how much money they can make. People wanna know how quickly they can make money. People wanna know how fast and if they don't need any skills or experience or any of those things to make money in the business opportunity niche. They wanna see Lamborghinis. They wanna see helicopters.  And there's no shortage of Instagrammers that are applying these exact same principles in order to sell whatever they're doing. Their stock tips or their crypto tips or their business opportunity courses. There's a million of these characters nowadays. And also let me know if you follow any like crazy interesting Instagrammers and let me know which ones you follow in the comments below and I will let you know my thoughts on them if I've heard of them before. Now the fifth golden rule of marketing is subscribe to this channel and like this video. No, that's not the fifth golden rule. Fifth golden rule is split test continuously. Split test continuously. If you are using free traffic methods and you are sending 50 DMs or private messages per day to people on social media, split test your messaging because one message may work way better than another. In fact, I can guarantee that different messaging will perform differently and if you continuously split test you may find that some messaging works 10 times or even a hundred times better than other messages or ads you have put out. Split test your traffic sources meaning if you're advertising a product and you're just breaking even on Google maybe you will make money if you put that same advertising on Bing. Another example is if you are advertising the top weight loss offer on ClickBank then you might wanna split test that against the top weight loss offer on a CPA network. One may make you more money than the other. I personally made most of my money from CPA networks. I found their offers are just way more aggressive. They make way more money. They have way better conversion rates especially when I was advertising free trial offers. I just raked in the dough. Lord thank you for Acai Berries and Garcinia Cambosia. The way I built my business to making over $10 million doing affiliate marketing was very simple. As I copied campaigns I would do the research I'd find winning campaigns and I'd implement them and I'd set up the advertising whether it was on Google or Facebook or Tabula or Outgrain or Bing or wherever and then I started building a team of people to continuously split test every aspect of the advertising. Now the folks that worked for me they I didn't pay them anything they only earned commission if they created a winning campaign if they created more money with their marketing but they didn't have to come up with anything from scratch again and neither do you.  That's my secret folks. So I hope this video helped you. Give this video a like if you learned something from this video. Let me know which of these tips in the comments below helped you out the most and I will focus in on that and do more videos in the future on that. Was it split testing continuously? Was it having a big picture mind but a laser-like focus? Was it copying winning campaigns? Was it never falling in love with a campaign? Or was it whatever the other thing I said was? Let me know. Thanks for watching. I hope you learned something and see you in my next video.


It looks like he's going to let you go, he got off the hook.  Wrestling, we make real stressful and real hard in our lives a lot of time. A lot of guys end up done with the sport and don't want to be near it ever again. It's tough being real good. Ask guys like this, it's tough being at the top. It's tough loving that over and over again with the ups and downs that comes with it. I want to see all you guys like us, just loving the sport, staying around, falling in love with other people chasing their dreams. Just falling in love with helping other people chase their dreams. It doesn't necessarily have to be a wrestler. So think about that, we make wrestling too big of a stressful thing in a weekend like this just fun. Some of the best guys in the state had to wrestle this weekend. A lot of times those cross town rivalry barriers don't ever get crossed, we cross some of those this weekend. So think about that. Think about that a lot as you're riding home the opportunities you got this weekend. And go create them for yourselves. Go create them for yourselves. But other than that man, I appreciate everybody coming. I hope everybody leaves here feeling like it was worth it. And then when we run this back again next year, you guys come back and take the same benefits and we just keep making it better and better and get more people involved. I appreciate everybody. Make sure you thank the guys that hosted this. Thank the people that got you here, some of these coaches spent their whole weekend away from their families to get some of you guys here. I appreciate that. Don't ever take it for granted. Wait a minute, wait a minute. Put your hands together for Cliff and Stephanie Prepwell.  This has been a massive undertaking. There's been a lot of sacrifice on your behalf or towards your behalf. We want you guys to have the best of everything. And this man, you know, he made phone calls, I mean, all over the nation getting some of the best coaches and talent out here. For why? I don't think he made a ton of money on this. He wanted you guys to get the benefit. I've had someone like Jamil Kelly having, shoot, Mark Munoz just gave up his time and it was such a blessing. It's an NCAA champion right there.  Just haphazardly put together. No, there's no such thing. The Lord orchestrated some amazing men that come into this room and to invest in all of your lives. And remember that. And he's exactly right, especially in this day, which you don't know yet. But we're going to go from here. And you know, maybe we're going to be like, this and that, but we are not going to be like that.  These kids are sophomore. I think you can get on podium three times. I think you win the state three times, to be honest. He's a monster. And I just met him right now. And I'm your biggest fan. I can't wait to see you go and handling. Okay, I'm really proud to know you. Super fun to wrestle with you. Where's a modern day San Diego kid? My goodness. So much talent coming out of this kid. I'm so excited about California wrestling right now, just today, being in the room with all these guys. And it's been, it's been a lot of work for us. So was it seeing all these eyes and all these smiles and all these men standing tall. After a two day grind like this. Man, it was awesome. Thank you guys for believing in this project. This is the first of anything like this in California. I don't know why this hasn't been done forever. Thank Cliff Fretwell for putting the idea together and bringing it out here. Thank you parents for believing in this. We want to grow this. We want all the best colleges in that balcony bidding for these kids. We want the college coaches fighting to give them money to give them scholarship. We got a little collection of scholarships up there. There's millions of millions of dollars of scholarship awarded in these names. There's millions of dollars of scholarships sitting right here in this pile of kids. We got to get these kids in front of the best coaches in the nation. We got to get these kids in front of the best opportunities. And so when Cliff was talking about this, man, I got fire in my chest for my state. I want my state to be all over the nation. You know, I have a lot of respect for Ohio, Pennsylvania, New Jersey, tons of respect. I want to smash them. I want to smash them in the next five years. Us, this group right here, I want to smash those states. And instead of Pennsylvania having all the NCAA, all Americans and this and that, let's start shifting that. We have some opportunities out here. We got some great colleges now. They're local. You know, we got Fresno State popping up. We got Arizona State right down the street. We got good stuff happening for our benefit in California. The last thing I'm going to say is this, the wrestling part, the training part, it's only part of it. And I know this will make your parents happy, but this is absolutely the truth. You've got to stay on top of your schooling. You've got to stay on top of your time management.    So you're going to have some friends that aren't champions. They're asking you to do non-champion activities. That is an enemy of your dreams.  You understand that? So dream real big. Dream real big. Think for yourself with a Harvard diploma.  Your dad's crying.  Make that dream really strong in your mind. Close your eyes every time you put your head on your pillow. Make that dream real strong. So anybody that's coming and asking you something that's an enemy of that dream, you'll be like, anyways, I got my dream and I'm going to my dream.  I'm not convinced. Do you guys understand? I need to see it. I need to see it. All right. Thank you guys for believing in Cliff and myself and this whole thing. And let's just grow this thing. We're going to have a bidding war here next year with all the best colleges in here. All right. No home. Enjoy the rest of your summer. Good job, guys. Thank you.


Welcome back to my channel. Today's video is going to be super fun because we are unbagging some Disney face masks I can't believe I'm making a mask video on my channel But I wanted to kind of spread the word make sure everyone is reminded to please wear a mask during this time It's very important. I just wanted to have some fun with it I guess that's pretty much it for this intro. Let's just get on to unbagging So the first pack I'm going to unbag is the Toy Story collection We pre-ordered these so when we pre-ordered we could only get sets. So they come in a pack of Four so basically you could not pick each individual mask that you want You had to buy an entire pack and I think one of us really wanted the 40 one I don't know if it was me or Valerie But let's go ahead and see what these things are all about. I have heard that they are really small So let's see. We got a little backing card here I think that's to keep them like nice and straight. We have this really big long tag here And I don't know if you can like I'm sure you can cut it out and stuff So this is what the first mask in the pack looks like it has all sorts of Toy Story characters It looks like a bunch of toys and or Disney characters. There's a character on here that looks like Nemo There's one on here that looks like Doug. There's one on here that looks like the bear from one of the movies I don't even know but there is also Buzz so that makes sense They are really tiny. Oh my gosh, so I'm gonna put this one on so I can show you guys. Oh My gosh.  I don't know if you guys can hear me It's so tight that it's like pulling my ears forward and It's so tight around my chin. Oh My gosh, it's so tight that like you can see my cheek is like Hoking out. Oh my gosh.  Ow my ears. I don't recommend purchasing this product Okay, I don't think they were that expensive and I think my mom got a discount because she works at Disney Oh my gosh, I'm just still so shocked. Okay moving on next up We have a Mike Wazowski big eyeball I'm not going to be trying the rest on because as you guys know and could see how they fit They're really tight. So this is the Mike Wazowski Mask and it just has the big eyeball. Oh, I think I was holding it upside down It's supposed to go like this.  So there's Woody There's the little green alien There is the dinosaur There is Buzz Lightyear and then there's some Incredibles There's some cars and there's little guy from up. This is what this mask looks like I don't know who is supposed to wear these Maybe these are made for children. The next mask is why we even purchased this pack pretty much But it is the one and only for key and he looks so confused. I love for key so much He's probably one of my favorite characters now, but this is what this mask looks like and I'm so sad that I can't really wear it So tight so tight moving on the next pack We purchased was the traditional Mickey Mouse pack and this just has like Mickey Mouse and like the classic characters I think or it's just Mickey Mouse So opening this one up. We have this little backer card. So the first one is pretty cool It's just Mickey Mouse. It has the traditional colors. So red yellow black and white very classic I love this pattern. This is what the first one looks like very traditional. I really like this one This is probably the one that I wanted just because it's really traditional very Disney-esque The next one is the one that Sherry wanted and the reason why we actually got this pack It is my favorite one as well probably even more so than the one I just showed you it is black and white Minnie Mouse and There's nothing. There's no color on it. This is what the black and white mask looks like Super cute and I really like this pattern I could see them make a little Duny and Burke bag out of this pattern and I think it would be so cute The next mask is this red one. It has Minnie Mouse in squares and then the background is polka dots Pretty simple still same color scheme as the other mask that I showed you the first one, but there's no yellow It's just the red black and white and the last and final mask I'm going to share with you guys is this blue one. It just has Mickey Mouse all over it and it's just blue It's just this navy blue mask and I really really like it. It's very C-Cruise-esque. I don't know. I just think of navy blue and light being like cruise ship I don't know. I associate it with being on a boat. So in conclusion These masks are a waste of money if you have toddlers slash kids I highly recommend them, but they are a no-go. I highly dislike them. I don't recommend them I think they're made okay The material is quite thick but my favorite mask patterns is the black and white version the Navy blue pattern and of course we gotta throw a four key in there because four keys one of my favorites So these are definitely my three favorites out of all the masks we purchased This is super random and if you made it this far in the video Comment a purple heart because it's super random and I just wanted to throw this in here really fast But I also got these gym shark leggings and they're so cute. I really like them I'm gonna make a whole entire video about my experience with gym shark Let me just say FedEx lost my package, but gym shark has amazing customer service So I just want to throw that in there because it is something new I purchased I ordered the matching top not too long ago because they were out of stock and I had to wait So I haven't even tried these I'm dying to try them But I've taken a couple photos in them and they're really cute So I just wanted to share those with you just as a little teaser for an upcoming video But anyway, that is going to be it for this video. Sorry about the lighting changes If you enjoyed this video and give it a thumbs up Don't forget to subscribe to my channel and I'll see you guys in my next video. Bye


The results of this study suggest that maternal lipid levels are not significantly associated with birth weight and called blood insulin levels. Instead, pre-pregnancy overweight, obesity appears to be the most influential upstream metabolic risk factor for both maternal and neonatal metabolic health. This implies that weight management should be addressed from the preconception period and during early pregnancy. This article was authored by Naived Sattar, Jin Hulu, Shou Chou, and others.